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


Emergency Assessment & Management

While waiting for confirmation of DKA, standard pediatric life support guidelines should be followed for assessment of airway, breathing and circulation, and the level of consciousness should be assessed using the GCS. Upon suspicion of DKA, initial laboratory work should be performed. The recommended initial assessment is summarized in Box 2.

Hemoglobin A1C assessment is useful, although it does not influence acute DKA management. Any home insulin pump devices should be removed. Precipitants, such as an infection, should be actively sought. If there is a history of fever, a blood culture and urine analysis should be considered. Inflammatory markers such as C-reactive protein[29] and a full blood count and differential are unlikely to help, as they are commonly abnormal with a left shift in DKA without the presence of an infection. An ECG may be required if there are potassium disturbances.

Children with DKA are best managed at a facility where written guidelines are available, with nursing and medical staff experienced in pediatric DKA management, preferably with pediatric endocrinology specialists overseeing care. Guidelines are available online[101] to assist providers who are unfamiliar with care; telephone consultations with a pediatric specialist may also be very helpful.


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