Submitted to: Electronic Publication
Publication Type: Other
Publication Acceptance Date: 6/25/2006
Publication Date: 9/25/2006
Citation: Jeha, G., Haymond, M.W. 2006. Approaches to the management of diabetic ketoacidosis in children and young adults. In: Rose, B.D., editors. UpToDate Online Journal [serial online]. Available: http://www.uptodate.com. Interpretive Summary:
Technical Abstract: Diabetic ketoacidosis (DKA) is a medical emergency characterized by hyperglycemia (blood glucose usually > 200 mg per dl), hyperketonemia (total ketone bodies > 5mM), and metabolic acidosis (pH < 7.30 and plasma bicarbonate < 15mEq per L), coupled with severe disturbances in fluid and electrolyte balance. Reports of mortality range from 0.5% to as high as 18%, but in most series of children and adolescents this generally in the 0.5% range. DKA is a particular problem for children and young adults with type 1 diabetes mellitus and is frequently associated with their initial presentation. With proper patient education, compliance with management instructions, and use of home glucose monitoring, subsequent episodes of DKA should be virtually preventable. Diabetic ketoacidosis has been primarily thought of as a complication of type 1 diabetes and particularly type 1 diabetes in children. We now recognize that children and adults with classical type 2 diabetes mellitus can and do present with DKA. We have little collective experience in the management and outcomes of DKA in the child or adolescent with type 2 diabetes. As a result the following discussion is based on our large experience in treating children with type 1 diabetes in DKA. But as of the present time, we have no a priori reason to believe that DKA in children with type 2 diabetes should be managed differently. This chapter reviews briefly the pathophysiology and diagnosis of DKA that provides the framework for the management of DKA in children and young adults. DKA and its complications, primarily cerebral edema, is the primary factor in the death of children and adolescents with diabetes. Therefore appropriate management of this medical emergency will have great impact in the longevity and quality of life of a number of selective children presenting with DKA. With the recent consensus conference on DKA sponsored by the Lawson Wilkins Pediatric Endocrinology Society and the European Society of Pediatric Endocrinology, new studies may be designed to improve upon our current management of these children, decrease the incidence, severity and complications of DKA among children with newly diagnosed diabetes and those non-compliant children with established diabetes (whether educated or not).