Diabetic Ketoacidosis

Abstract

The current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema are reviewed in this chapter. Based on the reviewed literature and on the author's experience, the most effi cient and recommended measures for DKA management are presented.Among the main fi ndings we would remark: (a) Normal saline solution (NaCl 0.9 %) remains as the preferred hydration solution. Hypotonic (diluted) solutions are avoided in the treatment of DKA. (b) there is a consensus regarding the contraindication of sodium bicarbonate administration to repair metabolic acidosis in DKA. (c) Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. In small babies with KAD and new onset diabetes, low insulin infusion rates (0.05 IU/kg/h) has been associated with few hypoglycemic episodes as well as with lower impact on the osmolarity, being protective for cerebral edema; (d) For fast corrections of glucose oscillations during DKA treatment, a practical scheme using two bags of electrolytic solutions is presented. (e) Cerebral edema, associated with DKA is a multifactorial process with different pathophysiological mechanisms. Depending on the associated risk for cerebral edema the most efficient treatment measures are reviewed.In conclusion: continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.