**Features at presentation**


#### **Therapeutic interventions**


#### **Changes in biochemical values during treatment**


#### **Warning signs and symptoms of cerebral edema include:**


Clinically significant cerebral edema usually develops 4–12 hours after treatment has start‐ ed, but can occur before treatment has begun or, rarely, may develop as late as 24–48 hours after the start of treatment. Symptoms and signs are variable. A method of clinical diagnosis based on bedside evaluation of neurological state is shown below [23]:

**•** Give mannitol 0.5-1 g/kg IV (2.5 ml/kg of 20% solution) over 20 minutes and repeat after 6

Diabetic Ketoacidosis: Clinical Practice Guidelines

http://dx.doi.org/10.5772/53020

309

**•** Hypertonic saline (3%), 5-10 mL/kg over 30 minutes, may be an alternative to mannitol or

**•** Intubation may be necessary for the patient with impending respiratory failure, but ag‐ gressive hyperventilation (to a pCO2 <2.9 kPa [22 mm Hg]) has been associated with poor

**•** After treatment for cerebral edema has been started, a cranial CT scan should be obtained to rule out other possible intracerebral causes of neurologic deterioration (10% of cases),

Home measurement of blood ß –OHB concentrations, when compared to urine ketone test‐ ing, decreases diabetes-related hospital visits (both emergency department visits and hospi‐ talizations) by the early identification and treatment of ketosis. Blood ß -OHB measurements may be especially valuable to prevent DKA in patients who use a pump because interrupted insulin delivery rapidly leads to ketosis. There may be dissociation between urine ketone (sodium nitroprusside only measures acetoacetate and acetone) and serum ß -OHB concen‐ trations, which may be increased to levels consistent with DKA when a urine ketone test is

A psychiatric social worker or clinical psychologist should be consulted to identify the psy‐ chosocial reason(s) contributing to development of DKA. Insulin omission can be prevented by schemes that provide education, psychosocial evaluation and treatment combined with adult supervision of insulin administration. Diabetes education of the child and his/her fam‐

**1.** DKA is the first presentation of ~25% of young diabetics. Cerebral edema is a major risk

**2.** The child is not a miniature adult. Children and adolescents with DKA should be man‐

aged in centers experienced in treatment and monitoring of DKA.

especially thrombosis or hemorrhage, which may benefit from specific therapy.

hours, if there is no initial response in 30 minutes to 2 hours

**•** Elevate the head of the bed

outcome and is not recommended.

**9. Prevention of recurrent DKA**

**10. Conclusion**

negative or shows only trace or small ketonuria [4].

**10.1. Future thoughts and recommendations**

causing mortality and morbidity.

ily is the cornerstone to prevent DKA occurrence and recurrence.

a second line of therapy if there is no initial response to mannitol

#### **7.2. Diagnostic criteria**


### *7.2.1. Major criteria*


#### *7.2.2. Minor criteria*


One diagnostic criterion, two major criteria, or one major and two minor criteria have a sen‐ sitivity of 92% and a false positive rate of only 4%.

A chart with the reference ranges for blood pressure and heart rate, which vary depending on height, weight, and gender, should be readily available, either in the patient's chart or at the bedside.
