Management of Diabetic Ketoacidosis |
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Authors: | Sindhu Sivanandan Aditi Sinha Vandana Jain Rakesh Lodha |
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Institution: | (1) Department of Pediatrics, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India; |
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Abstract: | Diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus (DM), occurs more commonly in children with
type 1 DM than type 2 DM. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities
result from a relative or absolute deficiency of insulin with or without an excess of counter-regulatory hormones. Management
requires careful replacement of fluid and electrolyte deficits, intravenous administration of insulin, and close monitoring
of clinical and biochemical parameters directed towards timely detection of complications, including hypokalemia, hypoglycemia
and cerebral edema. Cerebral edema may be life threatening and is managed with fluid restriction, administration of mannitol
and ventilatory support as required. Factors precipitating the episode of DKA should be identified and rectified. Following
resolution of ketoacidosis, intravenous insulin is transitioned to subcutaneous route, titrating dose to achieve normoglycemia. |
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Keywords: | |
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