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Current perspectives for treating children with diabetic ketoacidosis

Jefferson P Piva1, Mauro Czepielewskii, Pedro Celiny R Garcia

  • 1Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. jpiva@pucs.br

Jornal De Pediatria
|November 2, 2007
PubMed

Insights

Diabetic ketoacidosis (DKA) in children is effectively treated with continuous regular insulin infusion and isotonic fluid replacement, which also prevents cerebral edema. This approach optimizes DKA management and patient outcomes.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Intensive Care Medicine

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus in children.
  • Understanding the physiopathology, diagnosis, and treatment of DKA is crucial for effective management.
  • Preventing cerebral edema, a potentially fatal complication, is a key aspect of DKA care.

Purpose of the Study:

  • To review current concepts in the physiopathology, diagnosis, and treatment of childhood DKA.
  • To outline preventive measures for cerebral edema in pediatric DKA cases.
  • To present evidence-based recommendations for DKA management.

Main Methods:

  • Literature search of MEDLINE using keywords: diabetes, ketoacidosis, hyperglycemia, cerebral edema.
  • Inclusion of studies in English, Portuguese, or Spanish, with priority for complete texts and pediatric focus.
  • Review of Brazilian pediatric intensive care unit DKA treatment guidelines and author experience.

Main Results:

  • Normal saline (0.9% NaCl) is preferred for rehydration over hypotonic solutions.
  • Sodium bicarbonate is contraindicated for correcting metabolic acidosis in DKA.
  • Continuous regular insulin infusion (0.1 IU/kg/h) without a loading dose is recommended.
  • A practical two-bag system for electrolyte solutions aids glucose control.
  • Physiopathology and treatment of cerebral edema are detailed.

Conclusions:

  • Continuous regular insulin infusion combined with isotonic fluid and electrolyte replacement is an effective DKA treatment.
  • This therapeutic strategy helps preserve plasma osmolarity.
  • The recommended treatment approach effectively prevents cerebral edema in pediatric DKA.
Abstract

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