Editorial: Diabetic ketoacidosis in children and adolescents: From epidemiological data to clinical aspects

Zucchini, Stefano; Bonfanti, Riccardo; Schiaffini, Riccardo; Passanisi, Stefano; Salzano, Giuseppina; Lombardo, Fortunato

doi:10.3389/fped.2023.1164946

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Among the most common complications of DKA in children and adolescents is AKI, which occurs in 43% to 64% of DKA episodes in children [75,76]. In one-fourth of DKA episodes, AKI is severe, suggesting severe volume depletion [77] and highlighting the need for a delicate balance between treating severe hypovolaemia but also avoiding excessive fluid replacement that may increase the risk for cerebral injury [78]. Awareness about this complication and early recognition of AKI are important also because potassium repletion should not be started if renal function is impaired and should be withheld until urine output is documented [46].…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

et al. 2023

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Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia, and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline and Scopus databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, between DKA and hyperosmolar hyperglycaemic state (HHS), and between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration, restoration of shifting electrolyte disorders and addressing underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention, and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.

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Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

et al. 2023

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“…Among the commonest complications of DKA in children and adolescents is AKI, which occurs in 43% to 64% of DKA episodes in children [60,61]. In one-fourth of DKA episodes AKI is severe, suggesting severe volume depletion [62], and highlighting the need for a delicate balance between addressing the need to treat severe hypovolaemia and the potential risk of excessive fluid replacement due to the risk for cerebral injury [63]. Awareness about this complication and early recognition of AKI are important also because potassium repletion should not be started if renal function is impaired and should be withheld until output is documented [42].…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Kostopoulou¹,

Sinopidis²,

Fouzas³

et al. 2023

Preprint

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DKA represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, T2DM in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, DKA and hyperosmolar hyperglycaemic state (HHS), or between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration and restoration of shifting electrolyte disorders and underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.

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Aspects of intensive therapy of diabetic ketoacidosis in pediatric practice (literature review)

Bykov,

Muravyeva

2024

Vestn. anesteziol. reanimatol.

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Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes mellitus that is associated with a high risk of cerebral edema (CE)and may result in death. DKA is characterized by acute hyperglycemia, ketonemia and metabolic acidosis in the setting of decreased levels of insulin and excessive levels of the counter regulatory hormones. Algorithms of intensive treatment of DKA include such steps as fluid replacement therapy, correction of electrolyte imbalances, and intravenous infusion of insulin, performed in order to resolve metabolic acidosis and hyperglycemia as well as to prevent the development of complications (CE and hypokalemia). The analysis of literature has shown that during fluid replacement the most preferred options are balanced crystalloid solutions (Hartman’s solution and Plasma-Lyte). Infusion therapy is divided into bolus (administration of crystalloid solutions at the rate of 10 ml / kg for 30-60 minutes) and maintenance (administration of solutions for 24-48 hours). Intravenous glucosesolutions (5–10 %) are infused when the patient’s blood glucose falls below 14–16 mmol/L. Electrolyte disturbances (hypokalemia and hyponatremia) are resolved by prompt intravenous infusion of potassium and sodium solutions. Intravenous infusion of insulin is started at the rate of 0.05–0.1 U/kg/h, not earlier than 1 hour after the initiation of fluid resuscitation. Successful treatment of DKA in pediatric practice relies on clear understanding of the pathophysiological mechanisms of this complication and knowledge of the doses of the pharmaceutical drugs and volumes of infusion solutions to be used.

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Editorial: Diabetic ketoacidosis in children and adolescents: From epidemiological data to clinical aspects

Cited by 3 publications

References 5 publications

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Aspects of intensive therapy of diabetic ketoacidosis in pediatric practice (literature review)

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