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[Treatment of severe diabetic ketoacidosis in children. A comparative study of two methods (author's transl)]
Insights
Continuous low-dose insulin infusion is as effective as intermittent injections for treating severe diabetic ketoacidosis in children. This method reduces complications like hypoglycemia and hypokalemia, offering a safer treatment option.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus in children.
- Current treatment protocols for severe DKA often involve insulin therapy, but complications can arise.
Purpose of the Study:
- To compare the efficacy and safety of continuous low-dose insulin infusion versus intermittent low-dose insulin injections in pediatric patients with severe DKA.
Main Methods:
- A study involving 15 children with severe DKA (pH < 7.10).
- Two treatment protocols were used: Protocol I (intermittent IV/IM insulin) and Protocol II (continuous IV insulin infusion added to rehydration solution).
- Rehydration and potassium supplementation were standardized across both groups.
Main Results:
- Both protocols effectively lowered glucose levels, increased venous pH, and reduced diuresis, glycosuria, and ketonuria.
- Protocol I resulted in three cases of hypoglycemia and three of hypokalemia.
- Protocol II showed no hypoglycemia and only one case of moderate hypokalemia.
Conclusions:
- Continuous low-dose insulin infusion is as effective as intermittent insulin therapy for severe pediatric DKA.
- Continuous infusion significantly reduces the incidence of hypoglycemia and hypokalemia.
- This method is simple, widely applicable, and offers improved safety in managing DKA in children.
Abstract:
Fifteen children with severe diabetic ketoacidosis (pH less than 7,10) were treated according to two protocols. Protocol I used in 7 patients, consisted in a low dose insulin therapy by intravenous and intramuscular injections. Protocol II consisted in a low dose continuous intravenous insulin therapy, with insulin added to the rehydration solution at constant concentration (22 U/l). Rehydration and potassium supplementation were similar in both methods. The fall of glucose concentration, rise in venous pH, fall of diuresis, glycosuria, ketonuria were similar in the two groups. With protocol I three hypoglycemias (greater than 4 mM) and three hypokalemias (greater than 3 mEq/l) did occur. With protocol II no hypoglycemia and only one moderate hypokalemia was observed. Thus, continuous infusion of insulin added to the rehydration solution, including isotonic bicarbonate, isotonic saline, glucose and electrolytes is as effective as discontinuous insulin infusion, but with a lower incidence of complications. In addition, this method has the advantage of being easy and applicable everywhere.