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.



Clinical guidelines

Clinical Practice Guideline: ISPAD Clinical Practice Consensus Guidelines 2014 Compendium: Diabetic ketoacidosis and hyperglycemic hyperosmolar state


Wolfsdorf, J, Allgrove, J, Craig, M, Edge, J, Glaser, N, Jain, V, Lee, W, Mun...

The following recommendations are based on currently available evidence and are intended only as a general guide to DKA management. Because there is considerable individual variability in presentation of DKA (ranging from mild with only minimal dehydration to severe with profound dehydration),some patients may require specific treatment that, in the judgment of the treating physician, may be within or, occasionally, outside the range of options presented here.

Clinical Practice Guideline: Type 1 Diabetes in Children and Adolescents


Wherrett, D, Huot, C, Mitchell, B, & Pacaud, D

This section addresses those areas of type 1 diabetes management that are specific to children. Key Messages: 1) Suspicion of diabetes in a child should lead to immediate confirmation of the diagnosis and initiation of treatment to reduce the likelihood of diabetic ketoacidosis (DKA). 2) Management of pediatric DKA differs from DKA in adults because of the increased risk for cerebral edema. Pediatric protocols should be used. 3) Children should be referred for diabetes education, ongoing care and psychosocial support to a diabetes team with pediatric expertise.

Clinical Practice Guideline: Diabetic ketoacidosis in children and adolescents: An update and revised treatment protocol


Metzger, D

The protocol assists the medical practitioner in calculating fluid and electrolyte replacement needs for individual patients and outlines a plan for initial assessment and ongoing monitoring.