[Hyperglycemic acute crisis in type 1 diabetes mellitus in youth].
Diabetic ketoacidosis (DKA) is the main hyperglycemic complication in type 1 Diabetes Mellitus (DM1). The basic principles in treatment have to be followed carefully. The patient with DKA has a very deep volume depletion. To restore the circulatory capacity is the first step. From this point on, the restoration of the lost fluids is slow, around 1% per hour, aiming at the correction of the metabolic disturbance already on and avoiding great fluctuations in osmolality, which increases the risk of having complications. Attention to the development of cerebral edema, which, once suspected, deserves an urgent treatment plan, trying to avoid neurologic sequelae or even death. Subcutaneous ultra-rapid insulin has been demonstrated to be efficient and easier to use. As the perfusion gets improved and the levels of insulin increase, the lipolysis is blocked, as well as the generation of ketones and so the acidemia tends to be solved. DKA is still a high-mortality condition. And to be in a hurry frequently leads to neurologic sequelae and even to a fatal outcome.
Damiani
Durval
D
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. durvald@iconet.com.br
Damiani
Daniel
D
D000208:Acute Disease; D000293:Adolescent; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000503:physiopathology; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male
D007004:Hypoglycemic Agents; D007328:Insulin