Pediatric DKA Management in the Era of Standardization
The biochemical definition of DKA proposed by the International Society of Paediatric and Adolescent Diabetes, European Society of Pediatric Endocrinology and Lawson Wilkins Pediatric Endocrine Society is as follows:
Infrequently, DKA may occur at lesser hyperglycemia (euglycemic ketoacidosis), particularly during pregnancy or in partially treated young children. It may also present with hypoglycemia (hypoglycemic ketoacidosis) that may lead to challenges with initial diagnosis or in differentiating the condition from other rare conditions in the very young, such as glycogen storage disease. Acute decompensation with DKA has been recognized with Type 2 diabetes mellitus (T2DM) presentation. The SEARCH for Diabetes in Youth, a large population-based study in the USA, reported a 7% incidence of presentation with DKA in T2DM. This is more likely to occur in the African–American population.
There is an arbitrary classification of the severity of acidosis based on venous pH values with limited utility in management decisions based on this categorization:
Definition
The biochemical definition of DKA proposed by the International Society of Paediatric and Adolescent Diabetes, European Society of Pediatric Endocrinology and Lawson Wilkins Pediatric Endocrine Society is as follows:
Hyperglycemia (blood glucose >200 mg/dl or >11 mmol/l)
Venous pH <7.3 or bicarbonate <15 mmol/l
Ketonemia (β-hydroxybutyrate [BOHB] >1 mmol/l) and/or ketonuria
Infrequently, DKA may occur at lesser hyperglycemia (euglycemic ketoacidosis), particularly during pregnancy or in partially treated young children. It may also present with hypoglycemia (hypoglycemic ketoacidosis) that may lead to challenges with initial diagnosis or in differentiating the condition from other rare conditions in the very young, such as glycogen storage disease. Acute decompensation with DKA has been recognized with Type 2 diabetes mellitus (T2DM) presentation. The SEARCH for Diabetes in Youth, a large population-based study in the USA, reported a 7% incidence of presentation with DKA in T2DM. This is more likely to occur in the African–American population.
There is an arbitrary classification of the severity of acidosis based on venous pH values with limited utility in management decisions based on this categorization:
Severe pH <7.1 or bicarbonate <5 mmol/l
Moderate pH <7.2 or bicarbonate <10 mmol/l
Mild pH<7.3 or bicarbonate <15 mmol/l
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