Diabetes ketoacidosis (DKA) is a serious complication of diabetes in children. According to the Merck Manuals, it is most common in patients with type 1 diabetes, which generally develops in children and adolescents, but can also present in adults. Diabetic patients fail to produce enough insulin or do not use insulin appropriately. Without insulin, glucose accumulates in the blood stream. When the body cannot use glucose, it starts to break down fat, which produces ketones, causing ketoacidosis.
Fluids
Children with DKA can become severely dehydrated due to several factors. The kidneys excrete the excess glucose in the bloodstream, which causes frequent urination and loss of fluid. Children with DKA who become nauseated can have frequent episodes of vomiting and low blood pressure due to fluid loss. Also, children with DKA may have altered mental status, with confusion and loss of consciousness, limiting their ability to drink fluids. So the initial treatment of DKA involves correcting dehydration with intravenous fluids. The amount of fluid necessary for children with this disease depends on their pre-illness weight. Intravenous fluids are given in rapid boluses or infusions. Once the child becomes stable, fluids are given on a continuous basis until the blood sugar levels begin to normalize and the child is taking food and liquids by mouth.
Insulin
Children with DKA have hyperglycemia, or high levels of glucose in the blood. Insulin is necessary to decrease the levels of sugar to an appropriate range. Initially, the insulin is given as a continuous intravenous infusion, until ketones are not detected in the urine or blood. According to the Merck Manuals, ketones clear within hours of proper insulin dosing. Glucose is added to the infusion of fluids once the levels of glucose fall to an acceptable range, as the continuous infusion of insulin can lead to low blood sugar, or hypoglycemia. Then the therapy changes to intermittent subcutaneous insulin.
Electrolytes
One of the more serious complications of DKA is an abnormal level of two important electrolytes, sodium and potassium. High potassium can lead to cardiac rhythm abnormalities. Sodium abnormalities can lead to cerebral edema, a complication that, according to the Merck Manuals, occurs primarily in children and less often in young adults or teenagers. Close monitoring of these electrolytes and appropriate correction is necessary to prevent these complications.
