Recent Consensus Statements in Pediatric Endocrinology: A Selective Review

Klein, M.; Sathasivam, Anpalakan; Novoa, Yeray; Rapaport, Robert

doi:10.1016/j.ecl.2009.09.003

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Initial intravenous fluid administration should begin immediately with an isotonic solution (0.9% sodium chloride) in a 10 to 20 ml/kg bolus over 1 to 2 hours. Subsequent fluid management (deficit replacement) should be with 0.9% normal saline for at least 4-6 hours; thereafter, deficit replacement should be with a solution with a tonicity greater than or equal to 0.45% saline with added potassium [ 14 , 20 , 25 ]. The remainder replacement intravenous fluid should be given over at least 48 hours.…”

Section: Dka: Pathophysiology Clinical Condition and Treatmentmentioning

confidence: 99%

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Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Savoldelli

Farhat

Manna

2010

Diabetol Metab Syndr

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DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.

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Section: Dka: Pathophysiology Clinical Condition and Treatmentmentioning

confidence: 99%

“…The remainder replacement intravenous fluid should be given over at least 48 hours. Urinary losses should not be added to the calculation of replacement fluids [ 14 , 20 , 25 ].…”

Section: Dka: Pathophysiology Clinical Condition and Treatmentmentioning

confidence: 99%

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Savoldelli

Farhat

Manna

2010

Diabetol Metab Syndr

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“…Treatment of diabetic ketoacidosis (DKA) was performed in the Paediatric Department under the care of the same Paediatric Diabetologist, according to the protocol [29]. Informed consent was obtained from the parents.…”

Section: Methodsmentioning

confidence: 99%

Cytokine response to diabetic ketoacidosis (DKA) in children with type 1 diabetes (T1DM)

et al. 2011

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“…Indications for admission to the intensive care unit include presence of severe DKA or risk factors for cerebral edema such as, age <5 yrs and new onset diabetes [19]. Severe DKA is more common in children with prolonged duration of symptoms, compromised circulation and depressed level of consciousness [16].…”

Section: Initial Assessment and Resuscitationmentioning

confidence: 99%

Management of Diabetic Ketoacidosis

et al. 2010

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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.

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Recent Consensus Statements in Pediatric Endocrinology: A Selective Review

Cited by 6 publications

References 16 publications

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Cytokine response to diabetic ketoacidosis (DKA) in children with type 1 diabetes (T1DM)

Management of Diabetic Ketoacidosis

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