Today, I review, link to, and excerpt from The Canadian Paediatric Society’s Current recommendations for management of paediatric diabetic ketoacidosis. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Paediatr Child Health. 2023 May 4;28(2):128-138. doi: 10.1093/pch/pxac119. eCollection 2023 May.
All that follows is from the above resource.
Abstract
Treatment of paediatric diabetic ketoacidosis (DKA) includes careful attention to fluids and electrolytes to minimize the risk of complications such as cerebral injury (CI), which is associated with high morbidity and mortality. The incidence of cerebral edema in paediatric DKA has not decreased despite the use of fluid-limiting protocols based on restricting early fluid resuscitation. New evidence suggests that early isotonic fluid therapy does not confer additional risk and may improve outcomes in some patients. Protocols and clinical practice guidelines are being adjusted, with a particular focus on recommendations for initial and ongoing fluids and electrolyte monitoring and replacement. Initial isotonic fluid resuscitation is now recommended for all patients in the first 20 to 30 minutes after presentation, followed by repletion of volume deficit over 36 hours in association with an insulin infusion, electrolyte supplementation, and careful monitoring for and management of potential CI.
Keywords: Cerebral edema; Cerebral injury; Diabetes mellitus; Diabetic ketoacidosis; Paediatric.
© Canadian Paediatric Society 2023. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
