Podcast 615: Pediatric DKA

<p><strong>Contributor: Ryan Circh, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Diabetic ketoacidosis (DKA) can be the initial presenting condition of undiagnosed diabetes type I in pediatric patients</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Unlike adults, children typically need less fluid (i.e. 10 mL/kg bolus for those in shock followed by maintenance)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Cerebral edema is a concern from rapid administration of fluids</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">An insulin drip at 0.1 units/Kg/hr should be started but a bolus isn’t required</span></li> </ul> <p><strong><em>Editor’s note:</em></strong> <em><span style= "font-weight: 400;">While conceptually similar, treatment for pediatric DKA is overall less aggressive (no bolus of insulin, less fluids, slower corrections, etc.).</span></em> <a href= "https://pubmed.ncbi.nlm.nih.gov/29897851/"><em><span style= "font-weight: 400;">Recent literature</span></em></a> <em><span style="font-weight: 400;">also continues to argue against cerebral edema being related to fluid management</span></em></p> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Hsia D, Tarai S, Alimi A, Coss-Bu J, Haymond M.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/25800410/"><span style= "font-weight: 400;">Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema.</span></a> <em><span style="font-weight: 400;">Pediatr Diabetes</span></em><span style="font-weight: 400;">. 2015;16(5):338-344. </span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Wolfsdorf J, Glaser N, Sperling M, American D.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/16644656/"><span style= "font-weight: 400;">Diabetic ketoacidosis in infants, children, and adolescents: A consensus