Diabetic ketoacidosis (DKA) is a common complication of diabetes in children, which needs hospitalisation and can be fatal. In most cases of diabetic ketoacidosis, death is caused due to cerebral edema or complication of DKA. Diabetic ketoacidosis (DKA) can be the first sign or presenting symptom in some cases of type 1 diabetes (before diabetes is diagnosed or they have any other symptoms). According to studies, about 20 to 40% of newly diagnosed patients of type 1 diabetes are admitted in DKA.
Duration of Diabetic ketoacidosis: with appropriate treatment (fluid replacement and insulin therapy), DKA can be corrected in about 24-48 hours (depending on the severity of DKA at presentation). In most cases, the duration of therapy is about 48 hours.
Treatment for DKA aims to correct the metabolic abnormalities of DKA such as high blood sugar level, high ketone levels and serum osmolality with insulin and fluids. Treatment of DKA includes:
Duration of fluid replacement: fluid is replaced slowly; if it is given at an excessive rate or more than required, it can cause brain swelling (cerebral edema). Most cases have a fluid deficit of about 10% or 100 ml/kg. Fluid is given intravenously (into a vein) slowly with the aim of replacing 50% of the fluid deficit during the first 12 hours of presentation and the remainder within the next 12-16 hours. As high blood sugar is corrected more rapidly than ketoacidosis (high blood ketone levels), glucose-containing fluids is given once the glucose falls to < 14 mmol/l to prevent the fall in blood glucose levels hypoglycaemia).
Duration of insulin therapy: insulin is given slowly as a continuous infusion and not as a bolus injection rapidly in the vein; it is given like a replacement fluid. Insulin therapy aims to stop further fat breakdown and formation of ketone and stabilise tissue function by allowing the cells to use glucose in the blood for fuel and drive the available potassium back into the body's cells. Intravenous insulin therapy is usually needed for the first 24 hours. Once blood glucose levels have fallen below 240 mg/dL (13.3 mmol/L) and the blood ketone levels is/ has become low, intravenous insulin therapy is usually stopped and normal insulin therapy is started. Intravenous insulin is given for one to two hours after subcutaneous insulin is started.
Resolution of DKA: when the blood glucose concentration decreases to less than 200 mg per dL, bicarbonate level reaches upto 18 mEq per L or greater and if the venous pH level is greater than 7.3, it indicates that DKA is corrected.
During the treatment of DKA, the patient is monitored closely and frequently. Blood glucose in blood, urea nitrogen, serum creatinine, sodium, potassium and bicarbonate levels are monitored frequently until the patient is stable. DKA can be fatal, but with proper and aggressive treatment most people with diabetic ketoacidosis recover completely. The most important aspect of DKA treatment is that fluids and insulin should be given slowly so that the blood sugar levels, dehydration and ketosis are corrected slowly.
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