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Diabetic Ketoacidosis

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Dr Hemchand K Prasad, Chennai    16 January 2018

  1. ISPAD 2014 guidelines should be followed to manage diabetic ketoacidosis (DKA) in children and adolescents.
  2. Normal saline remains the preferred fluid of initial choice.
  3. Insulin initial dose remains at 0.05 IU/kg/hour and may be escalated to 0.1 IU/kg/hour, based on the clinical scenario.
  4. No insulin bolus should be given.
  5. Bicarbonate therapy is indicated in life threatening hyperkalemia and severe myocardial dysfunction due to acidosis.
  6. Document potassium levels prior to starting therapy.
  7. Cerebral edema remains the most important cause of morbidity and mortality in DKA, and is usually iatrogenic.
  8. Central line, catheterization and intubation is deferred, and must be performed only if necessary.
  9. DKA monitoring chart is the key to optimal outcome.
  10. Urine ketone testing is mandatory to prevent the next DKA.
  11. Team approach is needed for optimal outcome.

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