Diabetic ketoacidosis in pediatrics: management update

The management of diabetic ketoacidosis has remained unchanged for several years. Lately, as more evidence has been available, practice has been modified to simplify the management and avoid complications. For the last twenty years patients admitted to the Pediatric Intensive Care Unit (PICU) at the University Pediatric Hospital, were managed following a protocol where the patient's volume deficit was calculated based on the degree of dehydration (mild, moderate, and severe) and then administered accordingly over 36 hours. Also, we administered an insulin IV bolus (0.1 u/kg) prior to starting the insulin drip. Our experience employing this approach in the pediatric population had been successful having no morbidity or mortality due to cerebral edema. Nevertheless, new evidence, based on studies and international consensus, suggest changes should be made in the management of DKA. It is the new consensus that patients should be rehydrated over 48 hour period, and that the initial insulin bolus should be avoided. Of course, it needs to be pointed out, that the clinical status of each patient is the barometer by which therapy should be tailored. The following information is the new suggested guideline in the management of DKA.