I can't recall any previous contributors to ADC calling for a summit meeting. But this month's ADC is all about challenges and Carol Inward and Timothy Chambers, from Bristol UK, call for the highest level attention to reviewing our management of diabetic ketoacidosis. They cite the static death rate, the poor understanding of the mechanism of cerebral oedema and the variability with which UK paediatricians, at least, treat the disorder. They suggest that theoretical considerations lead to their conclusion that DKA should be regarded as analogous to hypertonic dehydration with renal electrolyte imbalance. Therefore dehydration might be better correctly more slowly and cautiously than is customary.

Inward and Chambers invite endocrinologists, nephrologists, general paediatricians and accident and emergency medicine specialists to put their minds to the problem. We join them in inviting the Royal College to convene an appropriate working party. Papers abroad, please copy. See page 443

Another problem . . . [Full text of this article]

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