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Diabetic Ketoacidosis is a complication of new or existing Type 1 Diabetes. Pediatric DKA may be complicated by cerebral edema and due to this risk, is treated differently than adult DKA. Health care providers must follow a published pediatric-specific protocol when treating pediatric DKA. We have chosen 3 examples of such protocols: a general treatment algorithm from the Canadian Diabetes Association, a detailed treatment algorithm from BC Children's Hospital (English) and a detailed treatment algorithm from Centre hospitalier universitaire Sainte-Justine (French). Each pediatric hospital in Canada will have a protocol that they follow, thus early communication with the diabetes specialist at your pediatric referral site is a key element of the management of these patients.

BROWSE EVIDENCE REPOSITORY

 

Key studies

Key Study: How can cerebral edema during treatment of diabetic ketoacidosis be avoided?

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Watts, W, & Edge, JA

This article discusses how DKA might be prevented from occurring in the first instance, known risk factors for cerebral edema, fluid and insulin management, the importance of careful monitoring during DKA treatment, and the importance of recognizing and acting on the earliest symptoms to prevent long-term harm.

Key Study: Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols

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Glaser, NS, Wootton-Gorges, SL, Buonocore, MH, Tancredi, DJ, Marcin, JP, Calt...

Previous studies show that vasogenic cerebral edema (CE) occurs during diabetic ketoacidosis (DKA) treatment in children, but the role of intravenous fluids in contributing to CE is unclear. We used magnetic resonance diffusion weighted imaging to quantify subclinical CE in children with DKA randomized to 2 intravenous fluid regimens.

Key Study: Dehydration in children with diabetic ketoacidosis: A prospective study

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Sottosanti, M, Morrison, GC, Singh, RN, Sharma, AP, Fraser, DD, Alawi, K, Sea...

Objective: To investigate the association between the degree of patient dehydration on presentation with diabetic ketoacidosis (DKA) and clinical and laboratory parameters obtained on admission.

Key Study: Measured degree of dehydration in children and adolescents with type 1 diabetic ketoacidosis

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Ugale, J, Mata, A, Meert, KL, & Sarnaik, AP

Objectives: 1) measure the degree of dehydration in children with type 1 diabetes mellitus and diabetic ketoacidosis based on change in body weight; and 2) investigate the relationships between measured degree of dehydration and clinically assessed degree of dehydration, severity of diabetic ketoacidosis, and routine serum laboratory values.

Key Study: Initial fluid resuscitation for patients with diabetic ketoacidosis: how dry are they?

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Fagan, MJ, Avner, J, & Khine, H

A prospective consecutive case series of patients aged 5 to 20 years who presented to a pediatric emergency department with diabetic ketoacidosis (DKA) was studied to determine the actual percent loss of body weight during an episode of DKA to determine the degree of dehydration and thereby provide a guide for hydration therapy during such an episode.

Key Study: Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration

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Edge, JA, Roy, Y, Bergomi, A, Murphy, NP, Ford-Adams, ME, Ong, KK, & Dunger, DB

Objective: To ascertain whether initial depression of conscious level in children with diabetic ketoacidosis (DKA) is related to hyperosmolality, acidosis or other factors.

Key Study: The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children

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Edge, JA, Jakes, RW, Roy, Y, Hawkins, M, Winter, D, Ford-Adams, ME, Murphy, N...

Cerebral oedema complicating diabetic ketoacidosis (DKA) remains the major cause of morbidity and mortality in children with type 1 diabetes, but its aetiology remains unknown. Our objective was to determine the impact of baseline biochemical factors and of treatment-related variables on risk of the development of cerebral oedema in children with DKA.

Key Study: Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis

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Lawrence, SE, Cummings, EA, Gaboury, I, & Daneman, D

Objectives: To determine incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada.

Key Study: Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics

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Glaser, N, Barnett, P, McCaslin, I, Nelson, D, Trainor, J, Louie, J, Kaufman,...

Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication are defined in this multicenter study.