Diabetic ketoacidosis in children and adolescents

Ketoacidosis is a serious complication of diabetes mellitus, especially type 1, and its secondary consequences account for a large proportion of diabetes-related hospitalizations and mortality in children with type 1 diabetes. Our understanding of the pathophysiology of ketoacidosis has increased considerably, together with methods and means of management. Nevertheless, its incidence has remained constant in most parts of the western world, as has the incidence of cerebral edema, the main cause of death due to ketoacidosis. Therefore, a major goal of clinical teams is to prevent ketoacidosis by early diagnosis of diabetes in new patients, and by appropriate treatment of intercurrent disease in patients with known diabetes, combined with family involvement and psychosocial interventions, as necessary. Although studies of the risk factors for the development of cerebral edema in this setting have yielded discrepant findings, there is a wide consensus regarding ketoacidosis treatment. The accepted protocol consists of slow rehydration with iso-osmotic fluids, without bicarbonate solution except in rare cases, with continuous attention to glucose, sodium and potassium levels and the patient's neurological state. The aim of this survey is to present guidelines for the treatment of diabetic ketoacidosis (DKA) in children and to recommend preventive measures.