CONTROVERSY

General paediatrics

Fluid management in diabetic ketoacidosis

C D Inward¹, T L Chambers¹

¹ Bristol Royal Hospital for Children, Bristol, UK

Correspondence to:
Correspondence to:
Dr C D Inward, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK

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Keywords: diabetic ketoacidosis; diabetes; fluid management; cerebral oedema

The first 150 words of the full text of this article appear below.

Young people with insulin dependent diabetes mellitus are three times more likely to die in childhood than the general population.¹ Despite advances in management over the past 20 years, the incidence of mortality associated with diabetic ketoacidosis (DKA) remains unchanged. Cerebral oedema is the predominant cause of this mortality; young children are particularly at risk, with an incidence of 0.7–1% of episodes of DKA.^2,3 The mortality appears to be greatest among patients at first presentation,^1,3,4 if there has been a long history of symptoms prior to admission,³ and during the first 24 hours of treatment.⁴ In a recently published retrospective multicentre analysis of children with DKA, low pCO₂ levels and high serum sodium concentration at presentation were identified as particular risk factors for the development of cerebral oedema, together with bicarbonate therapy.⁵ However, in the accompanying editorial, Dunger and Edge point out that this may simply be . . . [Full text of this article]

J Edge²

² John Radcliffe Hospital, Headley Way, Headington, Oxon OX3 9DU, UK

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• Martin, C., Southall, A., Liveley, K., Shea, E., Whitehead, K. (2009). Multisystemic Therapy Applied to the Assessment and Treatment of Poorly Controlled Type-1 Diabetes: A Case Study in the U.K. National Health Service. Clinical Case Studies 8: 366-382 [Abstract]  
• Koul, P. B. (2009). Diabetic Ketoacidosis: A Current Appraisal of Pathophysiology and Management. CLIN PEDIATR 48: 135-144 [Abstract]  
• Della Manna, T., Steinmetz, L., Campos, P. R., Farhat, S. C.L., Schvartsman, C., Kuperman, H., Setian, N., Damiani, D. (2005). Subcutaneous Use of a Fast-Acting Insulin Analog: An alternative treatment for pediatric patients with diabetic ketoacidosis. Diabetes Care 28: 1856-1861 [Abstract] [Full Text]  
• Puliyel, J M, Bhambhani, V (2003). Ketoacid levels may alter osmotonicity in diabetic ketoacidosis and precipitate cerebral edema. Arch. Dis. Child. 88: 366-366 [Full Text]  
• Carlotti, A P C P, Bohn, D, Halperin, M L (2003). Importance of timing of risk factors for cerebral oedema during therapy for diabetic ketoacidosis. Arch. Dis. Child. 88: 170-173 [Abstract] [Full Text]  
• Marcovitch, H. (2003). Atoms. Arch. Dis. Child. 88: 95-95 [Full Text]  
• Harris, G D, Fiordalisi, I (2002). Physiologic management of DKA. Arch. Dis. Child. 87: 451-452 [Full Text]  

eLetters:

Read all eLetters

Fluid therapy and diabetic ketoacidosis: the intensive care perspective

Andrew Durward, et al.

ADC Online, 18 Jun 2002 [Full text]

Physiologic management of DKA

Glenn D Harris, et al.

ADC Online, 3 Jul 2002 [Full text]

Re: Fluid management in diabetic ketoacidosis

Tapabrata Chatterjee

ADC Online, 2 Sep 2002 [Full text]

Ketoacid levels may alter osmotonicity in diabetic ketoacidosis and precipitate cerebral edema

Jacob M Puliyel, et al.

ADC Online, 21 Dec 2002 [Full text]

A DKA Summit?

Timothy Lachlan Chambers

ADC Online, 7 Jan 2003 [Full text]