[Hyperglycaemic crises in children and adolescents].

Area of Science:

• Pediatric Endocrinology
• Metabolic Disorders
• Clinical Guidelines

Background:

• Diabetic ketoacidosis (DKA) involves hyperglycemia, ketosis, and acidosis, with cerebral edema as a severe complication.
• Hyperglycemic hyperosmolar syndrome (HHS) is marked by hyperglycemia, hyperosmolarity, dehydration, and potential multi-organ failure.
• A new guideline from the Paediatric Association of the Netherlands (NVK) addresses DKA and HHS treatment in children.

Purpose of the Study:

• To outline the NVK's updated recommendations for managing DKA and HHS in pediatric patients.
• To differentiate treatment strategies for DKA and HHS, contrasting with other guidelines.
• To provide evidence-based approaches for preventing complications like cerebral edema.

Main Methods:

• The guideline distinguishes between DKA and HHS treatment protocols.
• Recommendations focus on the pace and type of fluid administration for rehydration.
• Specific guidance is provided on insulin dosage and timing for both conditions.

Main Results:

• Preventing cerebral edema in DKA requires slow rehydration and metabolic correction; hypotonic fluids are not advised.
• In DKA, correcting hyperglycemia is secondary to careful rehydration, with low-dose insulin initiation.
• For HHS, initial treatment prioritizes correcting intravascular hypovolemia through fluid replacement; insulin is considered if glucose levels do not adequately decrease.

Conclusions:

• The NVK guideline provides distinct, cautious approaches to DKA and HHS management in children.
• Slow, careful fluid and metabolic correction are key to preventing DKA complications.
• Aggressive fluid resuscitation is the primary intervention for HHS, with insulin as a secondary consideration.