Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S106 (doi:10.1542/peds.2007-2022NN)
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ENDOCRINOLOGY


MANAGEMENT OF DIABETIC KETOACIDOSIS: SUCCESSFUL MANAGEMENT EXPERIENCE OF MORE THAN 32 YEARS

Surendra Varma and Michael Bourgeois

Texas Tech University Health Sciences Center, Lubbock, Texas

ABSTRACT

INTRODUCTION: Diabetic ketoacidosis (DKA) in children and adolescents has a mortality rate of 1% to 2%. The proper management of DKA requires intense monitoring and clear understanding of pathophysiology related to it. Potential complications include cerebral edema, hypokalemia, hypoglycemia, and relapse.

OBJECTIVE: Our goal was to describe our long-term experience in the management of diabetic ketoacidosis in children.

METHODS: This study comprised a 32-year experience of managing DKA in the pediatric age group. More than 900 episodes of DKA were encountered during this period. The age range of patients was from 9 months to 18 years. These episodes included patients presenting with new-onset type 1 diabetes as well as known patients with recurrent DKA. All patients were managed in a PICU by residents directly supervised by Dr Varma following an established protocol, including careful monitoring and paying particular attention to avoiding complications.

RESULTS: In >900 admissions during this period, the mortality rate was 0%, and the incidence of cerebral edema was <0.1%. Hypoglycemia and relapse occurred in <1% of the cases. The only occurrence of severe hypoglycemia (electrocardiographic changes and arrhythmia) was in a patient who was transferred from an outlying hospital after 36 hours of inappropriate treatment.

CONCLUSIONS: Our experience demonstrates that children with DKA can be managed successfully with minimal complications by adhering to the following principles:

  1. early recognition and rapid transport to an ICU with experienced staff and physicians; and
  2. adherence to well-established standards of treatment, including:

Submitted by Surendra Varma