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Diabetic Ketoacidosis

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Abstract

The current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema are reviewed in this chapter. Based on the reviewed literature and on the author’s experience, the most efficient and recommended measures for DKA management are presented.

Among the main findings we would remark: (a) Normal saline solution (NaCl 0.9 %) remains as the preferred hydration solution. Hypotonic (diluted) solutions are avoided in the treatment of DKA. (b) there is a consensus regarding the contraindication of sodium bicarbonate administration to repair metabolic acidosis in DKA. (c) Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. In small babies with KAD and new onset diabetes, low insulin infusion rates (0.05 IU/kg/h) has been associated with few hypoglycemic episodes as well as with lower impact on the osmolarity, being protective for cerebral edema; (d) For fast corrections of glucose oscillations during DKA treatment, a practical scheme using two bags of electrolytic solutions is presented. (e) Cerebral edema, associated with DKA is a multifactorial process with different pathophysiological mechanisms. Depending on the associated risk for cerebral edema the most efficient treatment measures are reviewed.

In conclusion: continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.

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Author information

Authors and Affiliations

  1. Pediatric Emergency and Critical Care Department, Hospital de Clinicas de Porto Alegre-Brazil, Rua Ramiro Barcelos, 2350 – 10 andar, Porto Alegre, (RS), CEP 90035-903, Brazil

    Jefferson P. Piva MD, PhD

  2. Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFGRS), Rua Ramiro Barcelos, 2350, Porto Alegre, (RS), CEP 90035-903, Brazil

    Jefferson P. Piva MD, PhD

  3. Pediatric Department, Hospital São Lucas da PUCRS, Av Ipiranga 6690. H. São Lucas da PUCRS – 5 andar, Porto Alegre, RS, 90.610-000, Brazil

    Pedro Celiny Ramos Garcia MD, PhD

  4. Pediatric Intensive Care Unit, H. São Lucas da PUCRS, Av Ipiranga 6690–5 andar, Porto Alegre, (RS), CEP 90.610-000, Brazil

    Pedro Celiny Ramos Garcia MD, PhD

  5. Department of Pediatrics, School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil

    Pedro Celiny Ramos Garcia MD, PhD

  6. Department of Pediatric Intensive Care Unit, Addenbrookes Hospital, Hills road, Cambridge, Cambridgeshire, CB2 0QY, UK

    Ricardo Garcia Branco MD, PhD

Authors
  1. Jefferson P. Piva MD, PhD
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  2. Pedro Celiny Ramos Garcia MD, PhD
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  3. Ricardo Garcia Branco MD, PhD
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Corresponding author

Correspondence to Jefferson P. Piva MD, PhD .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Piva, J.P., Garcia, P.C.R., Branco, R.G. (2014). Diabetic Ketoacidosis. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_7

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  • DOI: https://doi.org/10.1007/978-1-4471-6416-6_7

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