MANAGEMENT OF DIABETIC KETOACIDOSIS: SUCCESSFUL MANAGEMENT EXPERIENCE OF MORE THAN 32 YEARS

Abstract

INTRODUCTION: Diabetic ketoacidosis (DKA) in children and adolescents has a mortality rate of 1% to 2%. The proper management of DKA requires intense monitoring and clear understanding of pathophysiology related to it. Potential complications include cerebral edema, hypokalemia, hypoglycemia, and relapse. OBJECTIVE: Our goal was to describe our long-term experience in the management of diabetic ketoacidosis in children. METHODS: This study comprised a 32-year experience of managing DKA in the pediatric age group. More than 900 episodes of DKA were encountered during this period. The age range of patients was from 9 months to 18 years. These episodes included patients presenting with new-onset type 1 diabetes as well as known patients with recurrent DKA. All patients were managed in a PICU by residents directly supervised by Dr Varma following an established protocol, including careful monitoring and paying particular attention to avoiding complications. RESULTS: In >900 admissions during this period, the mortality rate was 0%, and the incidence of cerebral edema was <0.1%. Hypoglycemia and relapse occurred in <1% of the cases. The only occurrence of severe hypoglycemia (electrocardiographic changes and arrhythmia) was in a patient who was transferred from an outlying hospital after 36 hours of inappropriate treatment. CONCLUSIONS: Our experience demonstrates that children with DKA can be managed successfully with minimal complications by adhering to the following principles: early recognition and rapid transport to an ICU with experienced staff and physicians; andadherence to well-established standards of treatment, including: proper fluid and electrolyte management aimed at avoiding overhydration and extreme levels of electrolytes;cautious correction of acidosis;slow, steady reductions in plasma glucose and avoidance of hypoglycemia;careful monitoring of clinical status (sensorium, state of hydration, vital signs, etc) and laboratory study results; andfrequent reassessment of the patient with adjustments and changes in treatment as dictated by the patient's needs.