Background: Diabetic ketoacidosis (DKA) is a medical emergency. The most physiologic fluid/electrolytes replacement rates and insulin dosis are still controversial.
Objective and hypotheses: To evaluate the effectiveness and security of DKA treatment. Our protocol consists of 2 h rehydration with 0.9% sodium chloride (NaCl), followed by insulin infusion (0.1 U/kg per h) associated to 0.45% NaCl with 5% glucose. Potassium is replaced with monophosphate potassium associated to potassium chloride in first 12 h. Lower insulin doses are used in children under 5y and mild DKA (0.05 U/kg per h).
Method: Retrospective study including children and adolescents with DKA at 1 DM diagnosis, attended at our hospital since 2004. DKA and severity groups were defined according to international literature. Data collected included insulin infusion, glycaemia, pH, osmolarity, corrected sodium, potassium and phosphate along the first 12 h. Statistical analysis with SPSS 21th (P<0.05).
Results: Since 2004 we admitted 142 new cases of 1DM. We included 38 children with DKA, 23 males (60%) with mean age of 8.2±4.0 years. Severe DKA occurred in 11 (28.9%), moderate DKA in 11 (28.9%) and mild DKA in 16 (42.2%). At admission, mean glycaemia was 554±154 mg/dl, mean osmolarity 310±12 mosm/kg, mean corrected sodium 146±5 mmol/l, mean potassium 4.5±0.72 mmol/l and mean phosphate 1.5±0.45 mmol/l. Insulin was started at a mean dose of 0.07±0.02 U/kg per h. Along 12 h, mean glucose supply was 4.8±1.8 g/U per h, mean potassium provided was 0.13±0.05 mmol/kg per h and mean phosphate was 0.11±0.06 mmol/kg per h. Potassium anf phosphate was started simultaneously with insulin infusion in 32 (84%) children; hypokalemia (<3.5 mmol/l) occurred in 16 (42%) children, and hypophosphatemia (<0.9 mmol/l) occurred in 10 (26%) cases. There was no hypocalcemia. Variation along 12 h had statistical significance for glycaemia, pH, corrected sodium and osmolarity (P<0.0001), without variation of corrected sodium. There were no cases of cerebral oedema.
Conclusion: Our protocol allowed an adequate and safe approach to DKA treatment at 1 DM onset. Hypocalcaemia should be corrected with higher potassium supply. There was a gradual correction of dehydration and acidosis, without complications.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology