Treatment algorithm of diabetic ketoacidosis in pediatric patients

Diabetic ketoacidosis (DKA) is the most important complication of diabetes mellitus. Medical history and physical examination are the cornerstones for DKA diagnosis, since they generally allow the physician to discover the precipitating factors and to determine the degree of patient dehydration. Laboratory work-up is very useful to monitor hyperglycemia, acid-base status and electrolytic imbalance at baseline. The goal of the first hour of treatment is fluid administration, generally of intravenous crystalloids, with reassessment of hydration status and potassium levels before starting insulin treatment which should be initiated at the second hour. Blood glucose and electrolyte serum level monitoring is essential for a successful treatment of DKA, mainly to avoid cerebral edema, which is the most serious complication of DKA. Fortunately such complication is rare. One of the risk factors associated to cerebral edema is the use of inadequate treatment or the use of some therapies that have been proposed which results are unclear.