Abstract

QUIROGA CASTANEDA, Sandra Milena; MENDOZA ROJAS, Víctor Clemente  and  PRADILLA ARENAS, German Lauro. Diabetic ketoacidosis in the pediatric population: management protocol. Rev. Univ. Ind. Santander. Salud [online]. 2013, vol.45, n.2, pp.57-63. ISSN 0121-0807.

Diabetic ketoacidosis is due to a state of insulin deficiency. Hyperglycemia> 200 mg / dL, metabolic acidosis with blood pH <7.3 or bicarbonate <15 mmol / L, ketonemia and ketonuria are its defining biochemical criteria. Management includes recognition of triggering cause of misbalance and its treatment, as well as careful assessment of the degree of dehydration, with re-hydration time considered to be between 24-48 hours. Patients with shock require crystalloid resuscitation, and use of vasoactive is a consideration. Once the shock is overcome, continued electrolyte replacement and intravenous crystalline insulin infusion at a rate of 0.1 U / kg / hour are called for, as are continued monitoring of clinical status and scheduled control of laboratory parameters, so as to achieve dynamic adjustment in therapy. The decline in blood glucose levels should be around 80 - 100 mg / dL / hour. When blood glucose levels reach about 250 mg / dL, the mix of intravenous fluids must be changed to dextrose solution; continue replacement of insulin until acidosis is resolved, at which point resumption of enteral feeding and switching to subcutaneous insulin are to be defined. Cerebral edema is a highly feared complication.

Keywords : Diabetic ketoacidosis; metabolic acidosis; insulin; dehydration; cerebral edema.

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