Diabetic ketoacidosis is a complication of new or existing pediatric diabetes and may be complicated by cerebral injury. Due to this risk, it 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. Key highlights include dehydration is a key component of DKA pathophysiology; all patients with DKA should receive a 20 ml/kg IV bolus of normal saline or Ringer's lactate over 20 minutes at the initiation of treatment, which can be repeated if the patient remains hypoperfused; ongoing fluids in DKA should be weight-based and account for the significant fluid deficit, with an increased maximum of 500 ml/hr; and every patient in DKA is at risk of cerebral injury before and during treatment, especially if DKA is more severe. Assess every patient with DKA for signs of cerebral injury and follow the TREKK DKA algorithm. In June 2023, TREKK’s DKA resources have been updated to reflect the 2022 International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines.
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