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Question 1: Treatment of mild to moderate ketoacidosis in children and adolescents with subcutaneous insulin
  1. D Mul1,
  2. Eva Molendijk2
  1. 1Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
  2. 2HagaZiekenhuis/Juliana Children's Hospital, The Hague, The Netherlands
  1. Correspondence to Dr D Mul, Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam 3011GT, The Netherlands; d.mul{at}diabeter.nl

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QUESTION

Is subcutaneous insulin as effective and safe as intravenous insulin in the treatment of mild to moderate diabetic ketoacidosis (DKA) in children and adolescents?

Clinical scenario

A 7-year-old girl comes to the emergency room with a short history of thirst, polyuria and weight loss. She looks mildly dehydrated at clinical examination. Her blood glucose is 25 mmol/L. There is a mild to moderate DKA with a pH of 7.20, pCO2 of 4.5 kPa and a base excess of −9.

A non-compliant 15-year-old adolescent, known to have diabetes type 1 for 7 years calls his paediatrician because he is not feeling well. His self-measured blood glucose is 33 mmol/L and his blood β-hydroxybutyrate is 3.5 mmol/L. The paediatrician advises him to come to the emergency room (ER). There, his blood gas shows a pH of 7.25, pCO2 of 5 kPa and a base excess of −7. Except for looking pale, his clinical examination is normal.

Structured clinical question

Is subcutaneous insulin therapy as effective and safe as intravenous insulin to treat mild to moderate DKA in children and adolescents with …

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