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Expert Review of Endocrinology & Metabolism Volume 7, 2012 - Issue 4
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Review

Pediatric diabetic ketoacidosis management in the era of standardization

Ildiko H Koves Seattle Children’s Hospital, Division of Endocrinology and Diabetes, 4800 Sand Point Way NE, Seattle, WA 98105, USA. [email protected]
&
Catherine Pihoker Seattle Children’s Hospital, Division of Endocrinology and Diabetes, 4800 Sand Point Way NE, Seattle, WA 98105, USA
Pages 433-443 | Published online: 10 Jan 2014

References

  • DIAMOND Project Group. Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999. Diabet. Med. 23(8), 857–866 (2006).
  • EURODIAB ACE Study Group. Variation and trends in incidence of childhood diabetes in Europe. Lancet 355(9207), 873–876 (2000).
  • Wolfsdorf J, Craig ME, Daneman D et al.; International Society for Pediatric and Adolescent Diabetes. Diabetic ketoacidosis. Pediatr. Diabetes 8(1), 28–43 (2007).
  • Wolfsdorf J, Craig ME, Daneman D et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr. Diabetes 10(Suppl. 12), 118–133 (2009).
  • Dunger DB, Sperling MA, Acerini CL et al.; ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch. Dis. Child. 89(2), 188–194 (2004).
  • Burge MR, Hardy KJ, Schade DS. Short-term fasting is a mechanism for the development of euglycemic ketoacidosis during periods of insulin deficiency. J. Clin. Endocrinol. Metab. 76(5), 1192–1198 (1993).
  • Pinkey JH, Bingley PJ, Sawtell PA, Dunger DB, Gale EA. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. The Bart’s-Oxford Study Group. Diabetologia 37(1), 70–74 (1994).
  • Guo RX, Yang LZ, Li LX, Zhao XP. Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy. J. Obstet. Gynaecol. Res. 34(3), 324–330 (2008).
  • Rewers A, Klingensmith G, Davis C et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics 121(5), e1258–e1266 (2008).
  • Pinhas-Hamiel O, Dolan LM, Zeitler PS. Diabetic ketoacidosis among obese African–American adolescents with NIDDM. Diabetes Care 20(4), 484–486 (1997).
  • Foster DW, McGarry JD. The metabolic derangements and treatment of diabetic ketoacidosis. N. Engl. J. Med. 309(3), 159–169 (1983).
  • McDonnell CM, Pedreira CC, Vadamalayan B, Cameron FJ, Werther GA. Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation? Pediatr. Diabetes 6(2), 90–94 (2005).
  • Rosenbloom AL. The management of diabetic ketoacidosis in children. Diabetes Ther. 1(2), 103–120 (2010).
  • Elding Larsson H, Vehik K, Bell R et al.; TEDDY Study Group; SEARCH Study Group; Swediabkids Study Group; DPV Study Group; Finnish Diabetes Registry Study Group. Reduced prevalence of diabetic ketoacidosis at diagnosis of Type 1 diabetes in young children participating in longitudinal follow-up. Diabetes Care 34(11), 2347–2352 (2011).
  • Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 343, d4092 (2011).
  • Neu A, Willasch A, Ehehalt S, Hub R, Ranke MB; DIARY Group Baden-Wuerttemberg. Ketoacidosis at onset of Type 1 diabetes mellitus in children – frequency and clinical presentation. Pediatr. Diabetes 4(2), 77–81 (2003).
  • Bui TP, Werther GA, Cameron FJ. Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience. Pediatr. Diabetes 3(2), 82–88 (2002).
  • Rewers M, LaPorte RE, King H, Tuomilehto J. Trends in the prevalence and incidence of diabetes: insulin-dependent diabetes mellitus in childhood. World Health Stat. Q. 41(3-4), 179–189 (1988).
  • Rewers A, Chase HP, Mackenzie T et al. Predictors of acute complications in children with Type 1 diabetes. JAMA 287(19), 2511–2518 (2002).
  • Hanas R, Ludvigsson J. Hypoglycemia and ketoacidosis with insulin pump therapy in children and adolescents. Pediatr. Diabetes 7(Suppl. 4), 32–38 (2006).
  • Cochran JB, Walters S, Losek JD. Pediatric hyperglycemic hyperosmolar syndrome: diagnostic difficulties and high mortality rate. Am. J. Emerg. Med. 24(3), 297–301 (2006).
  • Zeitler P, Haqq A, Rosenbloom A, Glaser N; Drugs and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment. J. Pediatr. 158(1), 9–14, 14.e1 (2011).
  • Vanelli M, Scarabello C, Fainardi V. Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. The Parma campaign. Acta Biomed. 79(1), 73–78 (2008).
  • Bui H, To T, Stein R, Fung K, Daneman D. Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J. Pediatr. 156(3), 472–477 (2010).
  • Neu A, Ehehalt S, Willasch A, Kehrer M, Hub R, Ranke MB. Varying clinical presentations at onset of Type 1 diabetes mellitus in children – epidemiological evidence for different subtypes of the disease? Pediatr. Diabetes 2(4), 147–153 (2001).
  • Flood RG, Chiang VW. Rate and prediction of infection in children with diabetic ketoacidosis. Am. J. Emerg. Med. 19(4), 270–273 (2001).
  • Smith CP, Firth D, Bennett S, Howard C, Chisholm P. Ketoacidosis occurring in newly diagnosed and established diabetic children. Acta Paediatr. 87(5), 537–541 (1998).
  • Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet 350(9090), 1505–1510 (1997).
  • Dalton RR, Hoffman WH, Passmore GG, Martin SL. Plasma C-reactive protein levels in severe diabetic ketoacidosis. Ann. Clin. Lab. Sci. 33(4), 435–442 (2003).
  • Koves IH, Neutze J, Donath S et al. The accuracy of clinical assessment of dehydration during diabetic ketoacidosis in childhood. Diabetes Care 27(10), 2485–2487 (2004).
  • Fagan MJ, Avner J, Khine H. Initial fluid resuscitation for patients with diabetic ketoacidosis: how dry are they? Clin. Pediatr. 47(9), 851–855 (2008).
  • Ugale J, Mata A, Meert KL, Sarnaik AP. Measured degree of dehydration in children and adolescents with Type 1 diabetic ketoacidosis. Pediatr. Crit. Care Med. 13(2), e103–e107 (2012).
  • Edge JA, Jakes RW, Roy Y et al. The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children. Diabetologia 49(9), 2002–2009 (2006).
  • Hoorn EJ, Carlotti AP, Costa LA et al. Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis. J. Pediatr. 150(5), 467–473 (2007).
  • Glaser N, Barnett P, McCaslin I et al.; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N. Engl. J. Med. 344(4), 264–269 (2001).
  • Adrogué HJ, Lederer ED, Suki WN, Eknoyan G. Determinants of plasma potassium levels in diabetic ketoacidosis. Medicine 65(3), 163–172 (1986).
  • Malone JI, Brodsky SJ. The value of electrocardiogram monitoring in diabetic ketoacidosis. Diabetes Care 3(4), 543–547 (1980).
  • Gibby OM, Veale KE, Hayes TM, Jones JG, Wardrop CA. Oxygen availability from the blood and the effect of phosphate replacement on erythrocyte 2,3-diphosphoglycerate and haemoglobin–oxygen affinity in diabetic ketoacidosis. Diabetologia 15(5), 381–385 (1978).
  • Keller U, Berger W. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetes 29(2), 87–95 (1980).
  • Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J. Clin. Endocrinol. Metab. 57(1), 177–180 (1983).
  • Zipf WB, Bacon GE, Spencer ML, Kelch RP, Hopwood NJ, Hawker CD. Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Diabetes Care 2(3), 265–268 (1979).
  • Winter RJ, Harris CJ, Phillips LS, Green OC. Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am. J. Med. 67(5), 897–900 (1979).
  • Soler NG, Bennett MA, Dixon K, FitzGerald MG, Malins JM. Potassium balance during treatment of diabetic ketoacidosis with special reference to the use of bicarbonate. Lancet 2(7779), 665–667 (1972).
  • Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis – a systematic review. Ann. Intensive Care 1(1), 23 (2011).
  • Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab. Res. Rev. 15(6), 412–426 (1999).
  • Vanelli M, Chiari G, Capuano C. Cost effectiveness of the direct measurement of 3-beta-hydroxybutyrate in the management of diabetic ketoacidosis in children. Diabetes Care 26(3), 959 (2003).
  • Noyes KJ, Crofton P, Bath LE et al. Hydroxybutyrate near-patient testing to evaluate a new end-point for intravenous insulin therapy in the treatment of diabetic ketoacidosis in children. Pediatr. Diabetes 8(3), 150–156 (2007).
  • Puttha R, Cooke D, Subbarayan A et al.; North West England Paediatric Diabetes Network. Low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with Type 1 diabetes – an observational study. Pediatr. Diabetes 11(1), 12–17 (2010).
  • Al Hanshi S, Shann F. Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr. Crit. Care Med. 12(2), 137–140 (2011).
  • Grimberg A, Cerri RW, Satin-Smith M, Cohen P. The ‘two bag system’ for variable intravenous dextrose and fluid administration: benefits in diabetic ketoacidosis management. J. Pediatr. 134(3), 376–378 (1999).
  • Poirier MP, Greer D, Satin-Smith M. A prospective study of the ‘two-bag system’ in diabetic ketoacidosis management. Clin. Pediatr. 43(9), 809–813 (2004).
  • Muir AB, Quisling RG, Yang MC, Rosenbloom AL. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes Care 27(7), 1541–1546 (2004).
  • Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res. Treat. 2011, 219706 (2011).
  • Keane S, Gallagher A, Ackroyd S, McShane MA, Edge JA. Cerebral venous thrombosis during diabetic ketoacidosis. Arch. Dis. Child. 86(3), 204–205 (2002).
  • Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J. Pediatr. 146(5), 688–692 (2005).
  • Glasgow AM. Devastating cerebral edema in diabetic ketoacidosis before therapy. Diabetes Care 14(1), 77–78 (1991).
  • Fiordalisi I, Harris GD, Gilliland MG. Prehospital cardiac arrest in diabetic ketoacidemia: why brain swelling may lead to death before treatment. J. Diabetes Complicat. 16(3), 214–219 (2002).
  • Couch RM, Acott PD, Wong GW. Early onset fatal cerebral edema in diabetic ketoacidosis. Diabetes Care 14(1), 78–79 (1991).
  • Shrestha SS, Zhang P, Albright A, Imperatore G. Medical expenditures associated with diabetes among privately insured U.S. youth in 2007. Diabetes Care 34(5), 1097–1101 (2011).
  • Maniatis AK, Goehrig SH, Gao D, Rewers A, Walravens P, Klingensmith GJ. Increased incidence and severity of diabetic ketoacidosis among uninsured children with newly diagnosed Type 1 diabetes mellitus. Pediatr. Diabetes 6(2), 79–83 (2005).
  • Laffel LM, Wentzell K, Loughlin C, Tovar A, Moltz K, Brink S. Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. Diabet. Med. 23(3), 278–284 (2006).
  • Guerci B, Tubiana-Rufi N, Bauduceau B et al. Advantages to using capillary blood beta-hydroxybutyrate determination for the detection and treatment of diabetic ketosis. Diabetes Metab. 31(4 Pt 1), 401–406 (2005).
  • Meas T, Taboulet P, Sobngwi E, Gautier JF. Is capillary ketone determination useful in clinical practice? In which circumstances? Diabetes Metab. 31(3 Pt 1), 299–303 (2005).
  • Kitabchi AE, Umpierrez GE, Murphy MB et al.; American Diabetes Association. Hyperglycemic crises in patients with diabetes mellitus. Diabetes Care 26(Suppl. 1), S109–S117 (2003).
  • Roe TF, Crawford TO, Huff KR, Costin G, Kaufman FR, Nelson MD Jr. Brain infarction in children with diabetic ketoacidosis. J. Diabetes Complicat. 10(2), 100–108 (1996).
  • Gutierrez JA, Bagatell R, Samson MP, Theodorou AA, Berg RA. Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis. Crit. Care Med. 31(1), 80–83 (2003).
  • Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in ontario children. Diabetes Care 25(9), 1591–1596 (2002).
  • Carvalho KS, Bodensteiner JB, Connolly PJ, Garg BP. Cerebral venous thrombosis in children. J. Child Neurol. 16(8), 574–580 (2001).
  • Kamat P, Vats A, Gross M, Checchia PA. Use of hypertonic saline for the treatment of altered mental status associated with diabetic ketoacidosis. Pediatr. Crit. Care Med. 4(2), 239–242 (2003).
  • Rosenbloom AL. Fatal cerebral infarctions in diabetic ketoacidosis in a child with previously unknown heterozygosity for factor V Leiden deficiency. J. Pediatr. 145(4), 561–562 (2004).
  • Worly JM, Fortenberry JD, Hansen I, Chambliss CR, Stockwell J. Deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous catheters. Pediatrics 113(1 Pt 1), e57–e60 (2004).
  • Rosenbloom AL. Hyperglycemic crises and their complications in children. J. Pediatr. Endocrinol. Metab. 20(1), 5–18 (2007).
  • Voitl P, Scheibenpflug C, Weber T, Janata O, Rokitansky AM. Combined antifungal treatment of visceral mucormycosis with caspofungin and liposomal amphotericin B. Eur. J. Clin. Microbiol. Infect. Dis. 21(8), 632–634 (2002).
  • Casteels K, Beckers D, Wouters C, Van Geet C. Rhabdomyolysis in diabetic ketoacidosis. Pediatr. Diabetes 4(1), 29–31 (2003).
  • Quiros JA, Marcin JP, Kuppermann N et al. Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. Pediatr. Crit. Care Med. 9(4), 418–422 (2008).
  • Haddad NG, Croffie JM, Eugster EA. Pancreatic enzyme elevations in children with diabetic ketoacidosis. J. Pediatr. 145(1), 122–124 (2004).

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