Pediatric diabetic ketoacidosis and hyperglycemic hyperosmolar state.
Diabetic ketoacidosis is an important complication of diabetes in children and is the most frequent diabetes-related cause of death in childhood. The pathophysiology of this condition can be viewed as an exaggeration of the normal physiologic mechanisms responsible for maintaining an adequate fuel supply to the brain and other tissues during periods of fasting and physiologic stress. The optimal therapy has been a subject of controversy, particularly because the most frequent serious complication of diabetic ketoacidosis-cerebral edema-and the relationship of this complication to treatment are incompletely understood. In this article, the author reviews the pathophysiology of diabetic ketoacidosis and its complications and presents an evidence-based approach to the management of this condition.
Glaser
Nicole
N
Department of Pediatrics, School of Medicine, University of California-Davis, 2516 Stockton Boulevard, Sacramento, CA 95817, USA. nsglaser@ucdavis.edu
D015746:Abdominal Pain / Q000209:etiology; D001639:Bicarbonates / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004573:Electrolytes / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use; D009325:Nausea / Q000209:etiology; D011141:Polyuria / Q000209:etiology; D013549:Sweetening Agents / Q000627:therapeutic use
D001639:Bicarbonates; D004573:Electrolytes; D007328:Insulin; D013549:Sweetening Agents; D005947:Glucose