Management of diabetic ketoacidosis in children and adolescents
Diabetic ketoacidosis (DKA) is the leading cause of death in children and adolescents with type 1 diabetes. DKA is a medical emergency that requires urgent hospital admission for expert management and administration of intravenous fluid, electrolytes and insulin.
If DKA is suspected based on clinical signs (ie dehydration, tachycardia, tachypnoea, deep sighing respiration, breath smelling of acetone, nausea and/or vomiting, abdominal pain, confusion, drowsiness, progressive decrease in level of consciousness), transfer the patient by ambulance to hospital.
Children and adolescents have particular responses to and complications of DKA, so adult protocols should not be used for resuscitation or to guide management unless the adolescent is aged over 16 years and is physically mature.
If the hospital does not have a local DKA protocol for children and adolescents and the expertise to treat the patient, immediately transfer the patient to a paediatric emergency department, or phone the nearest children’s hospital for specialist endocrinology advice.
If necessary, while awaiting specialist advice, apply general principles of resuscitation1. However, avoid giving excess fluid if rehydration of the child is started, because this may lead to cerebral oedema, a rare but life-threatening complication of managing DKA in children. Early signs of cerebral oedema are headache, and irritability or an altered conscious state. Late signs of cerebral oedema are bradycardia, increased blood pressure and depressed respiration.