Management of diabetic ketoacidosis.
Diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus (DM), occurs more commonly in children with type 1 DM than type 2 DM. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities result from a relative or absolute deficiency of insulin with or without an excess of counter-regulatory hormones. Management requires careful replacement of fluid and electrolyte deficits, intravenous administration of insulin, and close monitoring of clinical and biochemical parameters directed towards timely detection of complications, including hypokalemia, hypoglycemia and cerebral edema. Cerebral edema may be life threatening and is managed with fluid restriction, administration of mannitol and ventilatory support as required. Factors precipitating the episode of DKA should be identified and rectified. Following resolution of ketoacidosis, intravenous insulin is transitioned to subcutaneous route, titrating dose to achieve normoglycemia.
Department of Pediatrics, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Sindhu
S
Sivanandan
Aditi
A
Sinha
Vandana
V
Jain
Rakesh
R
Lodha
D001639:Bicarbonates / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology / Q000517:prevention & control; D002648:Child; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005440:Fluid Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D010710:Phosphates / Q000008:administration & dosage; D011188:Potassium / Q000008:administration & dosage; D012307:Risk Factors
D001639:Bicarbonates; D007004:Hypoglycemic Agents; D007328:Insulin; D010710:Phosphates; D011188:Potassium