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Diabetic ketoacidosis is a complication of new or existing pediatric diabetes and may be complicated by cerebral injury. Due to this risk, is treated differently than adult DKA. Health care providers must follow a published pediatric-specific protocol when treating pediatric DKA. Early communication with the diabetes specialist at your pediatric referral site is a key element of the management of these patients.

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Key Resources English (5) French (4) All (9)

Diabetic Keotacidosis Algorithm

Download

TREKK Diabetic Ketoacidosis PedsPac

An algorithm for recognizing and managing pediatric diabetic ketoacidosis

Diabetic Ketoacidosis Pocket Card

Download

TREKK Diabetic Ketoacidosis PedsPac

A pocket guide to red flags for pediatric diabetic ketoacidosis

Diabetic Ketoacidosis Order Set

Download

TREKK Diabetic Ketoacidosis PedsPac

This order set is for management of pediatric diabetic ketoacidosis in the ED. This document is adaptable to your hospitals form policy. Published online: March 2020, Version 1.3.

VIDEO: DKA in Kids

Visit

Bottom Line Recommendations: Diabetic Ketoacidosis

Download

Reid S, and TREKK Network

Bottom line recommendations for the treatment and management of diabetic ketoacidosis (DKA).

Feuille Dordonnances Pr-Rdiges pour d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

This order set is for management of pediatric diabetic ketoacidosis in the ED. This document is adaptable to your hospitals form policy. Published online: Mars 2020, Version 1.3 - French.

Carte de Poche d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

A pocket guide to red flags for pediatric diabetic ketoacidosis - French

Algorithme Pediatrique pour d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

An algorithm for recognizing and managing pediatric diabetic ketoacidosis - French

Recommandations de Base: Acidose Diabetique

Download

Reid S, and TREKK Network

Bottom line recommendations for the treatment and management of diabetic ketoacidosis (DKA) - French

Diabetic Keotacidosis Algorithm

Download

TREKK Diabetic Ketoacidosis PedsPac

An algorithm for recognizing and managing pediatric diabetic ketoacidosis

Diabetic Ketoacidosis Pocket Card

Download

TREKK Diabetic Ketoacidosis PedsPac

A pocket guide to red flags for pediatric diabetic ketoacidosis

Diabetic Ketoacidosis Order Set

Download

TREKK Diabetic Ketoacidosis PedsPac

This order set is for management of pediatric diabetic ketoacidosis in the ED. This document is adaptable to your hospitals form policy. Published online: March 2020, Version 1.3.

Feuille Dordonnances Pr-Rdiges pour d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

This order set is for management of pediatric diabetic ketoacidosis in the ED. This document is adaptable to your hospitals form policy. Published online: Mars 2020, Version 1.3 - French.

Carte de Poche d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

A pocket guide to red flags for pediatric diabetic ketoacidosis - French

Algorithme Pediatrique pour d'Acidose Diabetique

Download

TREKK Diabetic Ketoacidosis PedsPac

An algorithm for recognizing and managing pediatric diabetic ketoacidosis - French

VIDEO: DKA in Kids

Visit

Bottom Line Recommendations: Diabetic Ketoacidosis

Download

Reid S, and TREKK Network

Bottom line recommendations for the treatment and management of diabetic ketoacidosis (DKA).

Recommandations de Base: Acidose Diabetique

Download

Reid S, and TREKK Network

Bottom line recommendations for the treatment and management of diabetic ketoacidosis (DKA) - French

Clinical guidelines English (5) French All (5)

Guideline: COVID in children with diabetes

Visit

International Society for Pediatric and Adolescent Diabetes (ISPAD)

The International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state provide comprehensive guidance for management of DKA in young people. Intravenous infusion of insulin for treating DKA may necessitate intensive care unit admission in hospitals in some parts of the world. During the Coronavirus Disease 2019 (COVID-19) pandemic, ICU services may need to be prioritised for care of affected individuals

Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Visit

National Institute for Health and Care Excellence

This guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends how to support children and young people and their families and carers to maintain tight control of blood glucose to reduce the long-term risks associated with diabetes.

ISPAD Clinical Practice Consensus Guideline: Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings-role of subcutaneous insulin

Visit

Priyambada L, Wolfsdorf JI, Brink SJ, Fritsch M, Codner E, Donaghue KC, Craig...

The International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guideline 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state provide comprehensive guidance for management of DKA in young people. Intravenous (IV) infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit (ICU) for IV insulin infusion. During the coronavirus 2019 (COVID-19) pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritized or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD 2018 guidelines, is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources. Specifically, this guideline summarizes evidence for the role of subcutaneous insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Visit

Wolfsdorf J, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling M, and...

Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline.

Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Type 1 Diabetes in Children and Adolescents

Visit

Wherrett D, Ho J, Huot C, et al

Diabetes mellitus is the most common endocrine disease and one of the most common chronic conditions in children. Type 2 diabetes and other types of diabetes, including genetic defects of beta cell function, such as monogenic and neonatal diabetes, are being increasingly recognized in children and should be considered when clinical presentation is atypical for type 1 diabetes. This section addresses those areas of type 1 diabetes management that are specific to children.

Guideline: COVID in children with diabetes

Visit

International Society for Pediatric and Adolescent Diabetes (ISPAD)

The International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state provide comprehensive guidance for management of DKA in young people. Intravenous infusion of insulin for treating DKA may necessitate intensive care unit admission in hospitals in some parts of the world. During the Coronavirus Disease 2019 (COVID-19) pandemic, ICU services may need to be prioritised for care of affected individuals

Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Visit

National Institute for Health and Care Excellence

This guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends how to support children and young people and their families and carers to maintain tight control of blood glucose to reduce the long-term risks associated with diabetes.

ISPAD Clinical Practice Consensus Guideline: Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings-role of subcutaneous insulin

Visit

Priyambada L, Wolfsdorf JI, Brink SJ, Fritsch M, Codner E, Donaghue KC, Craig...

The International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guideline 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state provide comprehensive guidance for management of DKA in young people. Intravenous (IV) infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit (ICU) for IV insulin infusion. During the coronavirus 2019 (COVID-19) pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritized or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD 2018 guidelines, is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources. Specifically, this guideline summarizes evidence for the role of subcutaneous insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Visit

Wolfsdorf J, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling M, and...

Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline.

Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Type 1 Diabetes in Children and Adolescents

Visit

Wherrett D, Ho J, Huot C, et al

Diabetes mellitus is the most common endocrine disease and one of the most common chronic conditions in children. Type 2 diabetes and other types of diabetes, including genetic defects of beta cell function, such as monogenic and neonatal diabetes, are being increasingly recognized in children and should be considered when clinical presentation is atypical for type 1 diabetes. This section addresses those areas of type 1 diabetes management that are specific to children.

Systematic reviews English (9) French All (9)

Application of bench studies at the bedside to improve outcomes in the management of severe diabetic ketoacidosis in children-a narrative review.

Visit

Ravikumar N, Bansal A.

In this review, we address a few key issues and the challenges faced in the management of severe diabetic ketoacidosis (DKA) in children, highlighting the existing standard of care, supported by evidence and bench studies.

Update and harmonisation of guidance for the management of diabetic ketoacidosis in children and young people in the UK

Visit

Rugg-Gunn CE, Deakin M, Hawcutt DB.

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. Careful and timely intervention is required to optimise glycaemic control and reduce the risk of mortality and devastating complications. Of these, cerebral oedema is the leading cause of death, with a mortality rate of approximately 25%. This article highlights the recent updates to UK fluid therapy guidelines for DKA and provides clinical context for the benefit of paediatricians and junior doctors in light of this new guidance.

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis.

Visit

Alhumaid S, Al Mutair A, Al Alawi Z, Rabaan AA, Alomari MA, Al Salman SA, et al.

To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [ 60 years old], male gender, BMI 30, blood glucose level > 1000 mg/dl, and anion gap 30 mEq/l.

Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis.

Visit

Cherubini V, Marino M, Carle F, Zagaroli L, Bowers R, Gesuita R.

To determine if diabetes awareness campaigns are an effective intervention to reduce diabetes ketoacidosis at diagnosis of type 1 diabetes in children and youth. This review demonstrated that DKA awareness campaigns are effective to reduce DKA among children and adolescents with type 1 diabetes and the core components that explain why these campaigns are effective.

Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus

Visit

Castellanos L, Tuffaha M, Koren D, Levitsky LL.

Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of 'ketone bodies' into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.

Fluid management in children with diabetic ketoacidosis

Visit

McGregor S, Metzger DL, Amed S, Goldman RD.

Previous research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration?

Fluid treatment for children with diabetic ketoacidosis: How do the results of the pediatric emergency care applied research network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (FLUID) Trial change our perspective?

Visit

Glaser N, Kuppermann N.

The optimal fluid treatment protocol for children with diabetic ketoacidosis (DKA) has long been a subject of controversy. Until recently, there was no high-quality evidence from randomized clinical trials to support an optimal guideline, and recommendations were mainly based on theoretical considerations. As a consequence, fluid treatment protocols for children with DKA vary between institutions (and countries). In June 2018, the results from the Fluid Therapies Under Investigation in DKA Trial conducted in the Pediatric Emergency Care Applied Research Network were published. This large, factorial-designed randomized controlled trial assessed neurological outcomes of 1387 children with DKA who were treated with one of four fluid protocols that varied in infusion rate and sodium content. In this commentary, we review and discuss the results of this new study and the implications for clinical care of DKA in children.

Systematic Review: Bicarbonate in diabetic ketoacidosis

Visit

Chua HR, Schneider A, and Bellomo R

Objective: This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA).

Systematic Review: Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults

Visit

Usher-Smith JA, Thompson MJ, Sharp SJ, and Walter FM

Objective: To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults.

Application of bench studies at the bedside to improve outcomes in the management of severe diabetic ketoacidosis in children-a narrative review.

Visit

Ravikumar N, Bansal A.

In this review, we address a few key issues and the challenges faced in the management of severe diabetic ketoacidosis (DKA) in children, highlighting the existing standard of care, supported by evidence and bench studies.

Update and harmonisation of guidance for the management of diabetic ketoacidosis in children and young people in the UK

Visit

Rugg-Gunn CE, Deakin M, Hawcutt DB.

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. Careful and timely intervention is required to optimise glycaemic control and reduce the risk of mortality and devastating complications. Of these, cerebral oedema is the leading cause of death, with a mortality rate of approximately 25%. This article highlights the recent updates to UK fluid therapy guidelines for DKA and provides clinical context for the benefit of paediatricians and junior doctors in light of this new guidance.

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis.

Visit

Alhumaid S, Al Mutair A, Al Alawi Z, Rabaan AA, Alomari MA, Al Salman SA, et al.

To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [ 60 years old], male gender, BMI 30, blood glucose level > 1000 mg/dl, and anion gap 30 mEq/l.

Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis.

Visit

Cherubini V, Marino M, Carle F, Zagaroli L, Bowers R, Gesuita R.

To determine if diabetes awareness campaigns are an effective intervention to reduce diabetes ketoacidosis at diagnosis of type 1 diabetes in children and youth. This review demonstrated that DKA awareness campaigns are effective to reduce DKA among children and adolescents with type 1 diabetes and the core components that explain why these campaigns are effective.

Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus

Visit

Castellanos L, Tuffaha M, Koren D, Levitsky LL.

Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of 'ketone bodies' into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.

Fluid management in children with diabetic ketoacidosis

Visit

McGregor S, Metzger DL, Amed S, Goldman RD.

Previous research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration?

Fluid treatment for children with diabetic ketoacidosis: How do the results of the pediatric emergency care applied research network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (FLUID) Trial change our perspective?

Visit

Glaser N, Kuppermann N.

The optimal fluid treatment protocol for children with diabetic ketoacidosis (DKA) has long been a subject of controversy. Until recently, there was no high-quality evidence from randomized clinical trials to support an optimal guideline, and recommendations were mainly based on theoretical considerations. As a consequence, fluid treatment protocols for children with DKA vary between institutions (and countries). In June 2018, the results from the Fluid Therapies Under Investigation in DKA Trial conducted in the Pediatric Emergency Care Applied Research Network were published. This large, factorial-designed randomized controlled trial assessed neurological outcomes of 1387 children with DKA who were treated with one of four fluid protocols that varied in infusion rate and sodium content. In this commentary, we review and discuss the results of this new study and the implications for clinical care of DKA in children.

Systematic Review: Bicarbonate in diabetic ketoacidosis

Visit

Chua HR, Schneider A, and Bellomo R

Objective: This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA).

Systematic Review: Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults

Visit

Usher-Smith JA, Thompson MJ, Sharp SJ, and Walter FM

Objective: To identify the factors associated with diabetic ketoacidosis at diagnosis of type 1 diabetes in children and young adults.

Key studies English (19) French All (19)

Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic.

Visit

Chambers MA, Mecham C, Arreola EV, Sinha M.

Infection with SARS-CoV-2 induces a proinflammatory state that causes hyperglycemia and may precipitate diabetic ketoacidosis (DKA) in patients with known or new-onset diabetes. We examined the trends in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic.

Serum Sodium Concentration and Mental Status in Children With Diabetic Ketoacidosis

Visit

Glaser NS, Stoner MJ, Garro A, Baird S, Myers SR, Rewers A, et al

Diabetic ketoacidosis (DKA) is typically characterized by low or low-normal serum sodium concentrations, which rise as hyperglycemia resolves. In retrospective studies, researchers found associations between declines in sodium concentrations during DKA and cerebral injury. We prospectively investigated determinants of sodium concentration changes and associations with mental status alterations during DKA.

Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis

Visit

Rewers A, Kuppermann N, Stoner MJ, Garro A, Bennett JE, Quayle KS, et al.

Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.

Low-Dose (0.05 Unit/kg/hour) vs Standard-Dose (0.1 Unit/kg/hour) Insulin in the Management of Pediatric Diabetic Ketoacidosis: A Randomized Double-Blind Controlled Trial.

Visit

Rameshkumar R, Satheesh P, Jain P, Anbazhagan J, Abraham S, Subramani S,

To compare the efficacy of insulin infusion of 0.05 Unit/kg/hour vs 0.1 Unit/kg/hour in the management of pediatric diabetic ketoacidosis (DKA).

Spike in Diabetic Ketoacidosis Rates in Pediatric Type 2 Diabetes During the COVID-19 Pandemic.

Visit

Chao LC, Vidmar AP, Georgia S.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) on the incidence of new-onset type 2 diabetes and diabetic ketoacidosis (DKA) is unclear. It is unknown whether the coincidence of DKA noted in adult patients with type 2 diabetes is an issue for youth during the coronavirus disease 2019 pandemic.

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study.

Visit

Jacob R, Weiser G, Krupik D, Takagi D, Peled S, Pines N, et al.

We aimed to examine the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on diabetic ketoacidosis (DKA) rates in children with type 1 diabetes (T1D).

Hypertension during Diabetic Ketoacidosis in Children.

Visit

DePiero A, Kuppermann N, Brown KM, Schunk JE, McManemy JK, Rewers A, et al.

To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension.

Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes.

Visit

Ghetti S, Kuppermann N, Rewers A, Myers SR, Schunk JE, Stoner MJ, et al.

This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors.

Key Study: Effect of potassium infusion on serum levels in children during treatment of diabetic ketoacidosis

Visit

Musaitif R and Basnet S

Objectives: to determine the effect of 40 mEq/L and 60 mEq/L infusions on potassium levels in children during treatment of DKA.

Key Study: Improving Emergency Department Management of Diabetic Ketoacidosis in Children

Visit

Baumer-Mouradian SH, Gray MP, Wolfgram PM, Kopetsky M, Chang F, Brousseau DC,...

Objectives: To use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months.

Key Study: Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program

Visit

Abulebda K, Whitfill T, Montgomery EE, Kirby ML, Ahmed RA, Cooper DD, Nitu ME...

Objectives: The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.

Acute Kidney Injury in Critically Ill Children Admitted to the PICU for Diabetic Ketoacidosis. A Retrospective Study.

Visit

Weissbach A, Zur N, Kaplan E, Kadmon G, Gendler Y, Nahum E.

Acute kidney injury in the critically ill pediatric population is associated with worse outcome. The aim of this study was to assess the prevalence, associated clinical variables, and outcomes of acute kidney injury in children admitted to the PICU with diabetic ketoacidosis.

Key Study: Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

Visit

Kuppermann N, Ghetti S, Schunk JE, et al

Background: Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades. Methods: This 13-center, randomized, controlled trial examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis.

Key Study: Adherence to a pediatric diabetic ketoacidosis protocol in children presenting to a tertiary care hospital

Visit

Ronsley R, Islam N, Ronsley C, Metzger DL, and Panagiotopoulos C

Objective: To review adherence to a provincial diabetic ketoacidosis (DKA) protocol and to assess factors associated with intravenous fluid administration and the length time on an insulin infusion.

Key Study: Resuscitation With Ringer's Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis

Visit

Bergmann KR, Abuzzahab MJ, Nowak J, Arms J, Cutler G, Christensen E, Finch M,...

Objective: The aims of this study were to describe the use of Ringer's lactate (LR) or normal saline (NS) for resuscitation among children with diabetic ketoacidosis (DKA) and compare the effect of fluid type on cost, length of stay, and rate of cerebral edema (CE).

Key Study: Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis

Visit

Yung M, Letton G, and Keeley S

Objective: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS).

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

Visit

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

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, Seabrook ...

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

Visit

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

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

Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic.

Visit

Chambers MA, Mecham C, Arreola EV, Sinha M.

Infection with SARS-CoV-2 induces a proinflammatory state that causes hyperglycemia and may precipitate diabetic ketoacidosis (DKA) in patients with known or new-onset diabetes. We examined the trends in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic.

Serum Sodium Concentration and Mental Status in Children With Diabetic Ketoacidosis

Visit

Glaser NS, Stoner MJ, Garro A, Baird S, Myers SR, Rewers A, et al

Diabetic ketoacidosis (DKA) is typically characterized by low or low-normal serum sodium concentrations, which rise as hyperglycemia resolves. In retrospective studies, researchers found associations between declines in sodium concentrations during DKA and cerebral injury. We prospectively investigated determinants of sodium concentration changes and associations with mental status alterations during DKA.

Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis

Visit

Rewers A, Kuppermann N, Stoner MJ, Garro A, Bennett JE, Quayle KS, et al.

Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.

Low-Dose (0.05 Unit/kg/hour) vs Standard-Dose (0.1 Unit/kg/hour) Insulin in the Management of Pediatric Diabetic Ketoacidosis: A Randomized Double-Blind Controlled Trial.

Visit

Rameshkumar R, Satheesh P, Jain P, Anbazhagan J, Abraham S, Subramani S,

To compare the efficacy of insulin infusion of 0.05 Unit/kg/hour vs 0.1 Unit/kg/hour in the management of pediatric diabetic ketoacidosis (DKA).

Spike in Diabetic Ketoacidosis Rates in Pediatric Type 2 Diabetes During the COVID-19 Pandemic.

Visit

Chao LC, Vidmar AP, Georgia S.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) on the incidence of new-onset type 2 diabetes and diabetic ketoacidosis (DKA) is unclear. It is unknown whether the coincidence of DKA noted in adult patients with type 2 diabetes is an issue for youth during the coronavirus disease 2019 pandemic.

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study.

Visit

Jacob R, Weiser G, Krupik D, Takagi D, Peled S, Pines N, et al.

We aimed to examine the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on diabetic ketoacidosis (DKA) rates in children with type 1 diabetes (T1D).

Hypertension during Diabetic Ketoacidosis in Children.

Visit

DePiero A, Kuppermann N, Brown KM, Schunk JE, McManemy JK, Rewers A, et al.

To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension.

Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes.

Visit

Ghetti S, Kuppermann N, Rewers A, Myers SR, Schunk JE, Stoner MJ, et al.

This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors.

Key Study: Effect of potassium infusion on serum levels in children during treatment of diabetic ketoacidosis

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Musaitif R and Basnet S

Objectives: to determine the effect of 40 mEq/L and 60 mEq/L infusions on potassium levels in children during treatment of DKA.

Key Study: Improving Emergency Department Management of Diabetic Ketoacidosis in Children

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Baumer-Mouradian SH, Gray MP, Wolfgram PM, Kopetsky M, Chang F, Brousseau DC,...

Objectives: To use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months.

Key Study: Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program

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Abulebda K, Whitfill T, Montgomery EE, Kirby ML, Ahmed RA, Cooper DD, Nitu ME...

Objectives: The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.

Acute Kidney Injury in Critically Ill Children Admitted to the PICU for Diabetic Ketoacidosis. A Retrospective Study.

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Weissbach A, Zur N, Kaplan E, Kadmon G, Gendler Y, Nahum E.

Acute kidney injury in the critically ill pediatric population is associated with worse outcome. The aim of this study was to assess the prevalence, associated clinical variables, and outcomes of acute kidney injury in children admitted to the PICU with diabetic ketoacidosis.

Key Study: Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

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Kuppermann N, Ghetti S, Schunk JE, et al

Background: Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades. Methods: This 13-center, randomized, controlled trial examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis.

Key Study: Adherence to a pediatric diabetic ketoacidosis protocol in children presenting to a tertiary care hospital

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Ronsley R, Islam N, Ronsley C, Metzger DL, and Panagiotopoulos C

Objective: To review adherence to a provincial diabetic ketoacidosis (DKA) protocol and to assess factors associated with intravenous fluid administration and the length time on an insulin infusion.

Key Study: Resuscitation With Ringer's Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis

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Bergmann KR, Abuzzahab MJ, Nowak J, Arms J, Cutler G, Christensen E, Finch M,...

Objective: The aims of this study were to describe the use of Ringer's lactate (LR) or normal saline (NS) for resuscitation among children with diabetic ketoacidosis (DKA) and compare the effect of fluid type on cost, length of stay, and rate of cerebral edema (CE).

Key Study: Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis

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Yung M, Letton G, and Keeley S

Objective: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS).

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, Caltagiro...

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, Seabrook ...

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: 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, and Daneman D

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

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CPEG Pediatric DKA Algorithm: Ongoing Management

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TREKK Network & Canadian Pediatric Endocrine Group

CPEG Pediatric DKA Algorithm: Ongoing Management

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TREKK Network & Canadian Pediatric Endocrine Group