Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

<p>Abstract</p> <p>DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of co...

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Main Authors: Savoldelli Roberta D, Farhat Sylvia CL, Manna Thais D
Format: Article
Language:English
Published: BMC 2010-06-01
Series:Diabetology & Metabolic Syndrome
Online Access:http://www.dmsjournal.com/content/2/1/41
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spelling doaj-1047df4a34024dd486e2e7620e8c548e2020-11-25T00:55:22ZengBMCDiabetology & Metabolic Syndrome1758-59962010-06-01214110.1186/1758-5996-2-41Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency departmentSavoldelli Roberta DFarhat Sylvia CLManna Thais D<p>Abstract</p> <p>DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.</p> http://www.dmsjournal.com/content/2/1/41
collection DOAJ
language English
format Article
sources DOAJ
author Savoldelli Roberta D
Farhat Sylvia CL
Manna Thais D
spellingShingle Savoldelli Roberta D
Farhat Sylvia CL
Manna Thais D
Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
Diabetology & Metabolic Syndrome
author_facet Savoldelli Roberta D
Farhat Sylvia CL
Manna Thais D
author_sort Savoldelli Roberta D
title Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
title_short Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
title_full Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
title_fullStr Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
title_full_unstemmed Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department
title_sort alternative management of diabetic ketoacidosis in a brazilian pediatric emergency department
publisher BMC
series Diabetology & Metabolic Syndrome
issn 1758-5996
publishDate 2010-06-01
description <p>Abstract</p> <p>DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.</p>
url http://www.dmsjournal.com/content/2/1/41
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