Treatment and complications of diabetic ketoacidosis in children

Treatment and complications of diabetic ketoacidosis in children
Last literature review version 16.3: October 2008 | This topic last updated: August 8, 2008
George S Jeha, MD
Morey W Haymond, MD
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Joseph I Wolfsdorf, MB, BCh
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Alison G Hoppin, MD

INTRODUCTION — Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (DM), ranging from 0.15 percent to 0.31 percent [1-3]. In addition, DKA also can occur in children with type 2 DM; this presentation is most common among youth of African-American descent [4-8]. (See "Classification of diabetes mellitus and genetic diabetic syndromes").

The management of DKA in children, which is based upon the large collective experience of children with type 1 DM, will be reviewed here (show table 1). There is limited experience in the management and outcomes of DKA in children with type 2 DM, although the same principles should apply. The clinical manifestations and diagnosis of DKA in children and the pathogenesis of DKA are discussed elsewhere. (See "Clinical features and diagnosis of diabetic ketoacidosis in children" and see "Epidemiology and pathogenesis of diabetic ketoacidosis and hyperosmolar hyperglycemic state").

DEFINITION — Consensus statements from the European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society (ESPE/LWPES) in 2004, from the American Diabetes Association (ADA) in 2006, and the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2007 defined biochemical criteria for the diagnosis of DKA [9-12]:

* Hyperglycemia, defined as a blood glucose of >200 mg/dL (11 mmol/L)

AND

* Metabolic acidosis, defined as a venous pH <7.3 and/or a plasma bicarbonate <15 meq/L (15 mmol/L)

These abnormalities are accompanied by disturbances in fluid and electrolyte balance, resulting in volume depletion and mild to moderate serum hyperosmolality. The clinical manifestations of DKA are related to the degree of hyperosmolality, volume depletion, and severity of acidosis [13]. (See "Clinical features and diagnosis of diabetic ketoacidosis in children").

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