Pediatric Diabetic Ketoacidosis Management in the Era of Standardization

Ildiko H Koves; Catherine Pihoker


Expert Rev Endocrinol Metab. 2012;7(4):433-443. 

In This Article

Clinical Manifestations & Presentation

Typical symptoms of DKA include polyuria, polydipsia, nocturia and polyphagia with weight loss (Box 1). Up to 80% of patients present with new-onset enuresis.[23] Abdominal pain, nausea, vomiting, headache and lethargy are often also present. Commonly, candida diaper rash or genital and/or urinary infection with dysuria is present in younger children. Patients with severe DKA may be confused or even comatose at presentation. Focal neurologic signs (e.g., cranial nerve palsies and double vision) may be present in CE.

The clinical signs of DKA include Kussmaul breathing with ketotic breath (Box 1). Patients with DKA are dehydrated, lethargic and may experience abdominal pain that could mimic appendicitis. The Glasgow Coma Scale (GCS) values are infrequently below 15, with improvement once fluid resuscitation is initiated.


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