Diagnostic and therapeutic approach of diabetic ketoacidosis in children and adolescents in the emergency department

Abstract

Diabetic ketoacidosis (DKA) is the most frequent complication in children with type 1 diabetes. DKA is due to a partial or complete insulin deficit, associated with an increase of counterregulatory hormones, which leads to the biochemical alterations that define the disease: hyperglycemia, metabolic acidosis and ketonemia. Most DKA related deaths are caused by complications associated with the initial treatment. To prevent complications, an adequate assessment in the emergency service is essential; gradual reposition of fluids, dextrose supplementation during hydration, and insulin therapy are necessary. This paper is a critical review of the physiopathology, clinical manifestations, treatment and main complications of DKA.