Insulin infusion via an intraosseous needle in diabetic ketoacidosis

Area of Science:

• Pediatric Endocrinology
• Emergency Medicine
• Critical Care

Background:

• Severe diabetic ketoacidosis (DKA) in children presents significant management challenges, especially when intravenous (IV) access is difficult.
• Current International Diabetes Society guidelines for DKA management do not explicitly mention intraosseous (IO) access.
• Alternative routes like subcutaneous or intramuscular insulin may be less effective in critical DKA scenarios.

Observation:

• A five-year-old child with severe DKA and dehydration could not obtain IV access at a remote hospital.
• Initial resuscitative fluids and continuous insulin infusion were successfully administered via an intraosseous needle.
• The patient's hyperglycemia and metabolic acidosis corrected rapidly, comparable to IV therapy, with no observed complications.

Findings:

• Intraosseous administration of insulin and fluids is a feasible and effective alternative to IV therapy in pediatric DKA when IV access is unattainable.
• The rate of correction for hyperglycemia and metabolic acidosis via IO route was comparable to traditional IV methods.
• No adverse events were noted during or after the intraosseous treatment.

Implications:

• IO access should be considered as a potential route for managing pediatric DKA with severe dehydration when IV access cannot be established.
• Reviewing and potentially updating DKA management guidelines to include IO access could improve emergency care for critically ill children.
• This approach ensures reliable delivery of essential resuscitation fluids and medications in challenging pediatric emergency situations.