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[Diabetic ketoacidosis in childhood: the first day of treatment]
A Miyares Gómez1, F Sánchez Medina, J Casado Flores
1Departamento de Pediatria, Hospital Infantil Niño Jesús, UAM, Madrid.
Insights
Low-dose intravenous insulin infusion effectively treats diabetic ketoacidosis in children. This safe and efficient method rapidly corrects blood sugar and pH, with minimal complications.
Area of Science:
- Pediatrics
- Endocrinology
- Intensive Care Medicine
Context:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes, particularly in children.
- DKA often presents as the initial manifestation of diabetes in pediatric patients.
- Mild infections are a common trigger for DKA in children.
Purpose:
- To evaluate the safety and efficacy of low-dose intravenous insulin infusion for treating pediatric diabetic ketoacidosis.
- To assess the time to correction of hyperglycemia and acidemia in children with DKA.
- To identify any complications associated with this treatment protocol.
Summary:
- A retrospective review of 15 pediatric patients with DKA treated with low-dose IV insulin infusion in the ICU.
- Sodium bicarbonate was administered only to patients in shock with a blood pH ≤ 7.10.
- Average correction times were 6.4 hours for pH and 5 hours for glycemia (target ≤ 250 mg/dL) at a rate of 120 mg/dL/h.
- One case of cerebral edema was observed; otherwise, the treatment was well-tolerated.
Impact:
- Low-dose intravenous insulin infusion is a safe and effective treatment for pediatric DKA.
- This protocol demonstrates rapid correction of metabolic derangements in DKA.
- The findings support the use of this therapeutic approach in pediatric intensive care settings.
Abstract:
Fifteen patients with diabetic ketoacidosis treated at ICU in the last eight years with low-dose intravenous insulin infusion are retrospectively revised. Diabetic ketoacidosis was the initial presentation of diabetes in 12 children. Mild infections were the usual starting factor. Only the children with shock of blood pH less than or equal to 7.10 on admission received sodium bicarbonate. The average of pH correction was 6.4 h. The average of glycemia correction (less than or equal to 250 mg/dl) was 5 h with a rate of 120 mg/dl/h. None of children had complications in the course of the treatment, except for one of them who presented cerebral edema. This procedure is a safe and efficacious treated for diabetic ketoacidosis in children.