ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Archives of Disease in Childhood

Volumn 89, Issue 2, 2004, Pages 188-194

  Dunger, D B ^a,b   Sperling, M A ^c   Acerini, C L ^b   Bohn, D J ^c   Daneman, D ^c   Danne, T P A ^b   Glaser, N S ^c   Hanas, R ^b   Hintz, R L ^c   Levitsky, L L ^c   Savage, M O ^b   Tasker, R C ^b   Wolfsdorf, J I ^c  

^a UNIVERSITY OF CAMBRIDGE   (United Kingdom)

^b Europ Soc Paediatr Endocrinol ^*  (United Kingdom)

^c Lawson Wilkins Pediatric Endocrine Society Obesity Committee

Author keywords

[No Author keywords available]

Indexed keywords

ATYPICAL ANTIPSYCHOTIC AGENT; BICARBONATE; DIAZOXIDE; GLUCOCORTICOID; IMMUNOSUPPRESSIVE AGENT; INFUSION FLUID; INSULIN; ISOTONIC SOLUTION; MANNITOL; PHOSPHATE; POTASSIUM; SODIUM CHLORIDE;

ACIDOSIS; BRAIN EDEMA; CLINICAL FEATURE; COLLOID; CRYSTALLOID; DIABETIC KETOACIDOSIS; DISEASE ASSOCIATION; DOSE RESPONSE; DRUG MEGADOSE; EPIDEMIOLOGICAL DATA; FLUID INTAKE; FLUID THERAPY; HEALTH PROGRAM; HEALTH PROMOTION; HUMAN; INCIDENCE; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN TREATMENT; LABORATORY TEST; MORBIDITY; MORTALITY; NONHUMAN; ONSET AGE; ORGANIZATION; PATHOPHYSIOLOGY; PATIENT MONITORING; PRIORITY JOURNAL; PROPHYLAXIS; REVIEW; RISK FACTOR; SALT INTAKE; TREATMENT OUTCOME;

ADOLESCENT; BRAIN EDEMA; CHILD; CHILD, PRESCHOOL; DIABETIC KETOACIDOSIS; EUROPE; FLUID THERAPY; HUMANS; INSULIN; PHOSPHATES; POTASSIUM DEFICIENCY;

EID: 10744220841     PISSN: 00039888     EISSN: 14682044     Source Type: Journal    
DOI: 10.1136/adc.2003.044875     Document Type: Review

References (114)

1. ADA. American Diabetes Association Position Statement: Hyperglycemic crises in patients with diabetes mellitus. Diabetes Care 2003;26(suppl 1):S1-S2.
2. ISPAD. Consensus guidelines, www.ispad.org, 2000.
3. Chase HP, Garg SK, Jelley DH. Diabetic ketoacidosis in children and the role of outpatient management. Pediatr Rev 1990;11:297-304.
4. Pinkey JH, et al. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. The Bart's sOxford Study Group. Diabetologia 1994;37:70-4.
5. Levy-Marchal C, et al. Clinical and laboratory features of type 1 diabetic children at the time of diagnosis. Diabet Med 1992;9:279-84.
6. Komulainen J, et al. Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group. Arch Dis Child 1996;75:410-15.
7. Curtis JR, et al. Recent trends in hospitalization for diabetic ketoacidosis in Ontario children. Diabetes Care 2002;25:1591-6.
8. Hirasing RA, et al. Trends in hospital admissions among children aged 0-19 years with type I diabetes in the Netherlands. Diabetes Care 1996;19:431-4.
9. Komulainen J, et al. Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes Care 1999;22:1950-5.
10. Alavi IA, Sharma BK, Pillay VK. Steroid-induced diabetic ketoacidosis. Am J Med Sci 1971 ;262:15-23.
11. Goldstein IE, et al. New-onset diabetes mellitus and diabetic ketoacidosis associated with olanzapine treatment. Psychosomatics 1999;40:438-43.
12. Smith CP, et al. Ketoacidosis occurring in newly diagnosed and established diabetic children. Acta Paediatr 1998;87:537-41.
13. Morris AD, et al. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet 1997;350:1505-10.
14. Rewers A, et al. Predictors of acute complications in children with type 1 diabetes. JAMA 2002;287:2511-18.
15. Rosilio M, et al. Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group. Diabetes Care 1998;21:1146-53.
16. Keenan HT, Foster CM, Bratton SL. Social factors associated with prolonged hospitalization among diabetic children. Pediatrics 2002;109:40-4.
17. Golden MP, Herrold AJ, Orr DP. An approach to prevention of recurrent diabetic ketoacidosis in the pediatric population. J Pediatr 1985;107:195-200.
18. Flood RG, Chiang VW. Rate and prediction of infection in children with diabetic ketoacidosis. Am J Emerg Med 2001;19:270-3.
19. Hoffman WH, et al. Service and education for the insulin-dependent child. Diabetes Care 1978;1:285-8.
20. Glasgow AM, et al. Readmissions of children with diabetes mellitus to a children's hospital. Pediatrics 1991;88:98-104.
21. Levitsky L, et al. Death from diabetes (DM) in hospitalized children (1970-1988). Pediatr Res 1991;29:A195 (abstract).
22. Cummings E, Lawrence S, Daneman D. Cerebral edema (CE) in pediatric diabetic ketoacidosis (DKA) in Canada. Diabetes 2003;52:A400 (abstract).
23. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child 1999;81:318-23.
24. Edge JA, et al. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001;85:16-22.
25. Glaser N, et al. Risk factors for cerebral edema in children with diabetic ketoacidasis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med 2001;344:264-9.
26. Bello FA, Sotas JF. Cerebral oedema in diabetic ketoacidosis in children. Lancet 1990;336:64.
27. Mahoney CP, Vlcek BW, DelAguila M. Risk factors for developing brain hemiation during diabetic ketoacidosis. Pediatr Neural 1999;21:721-7.
28. Harris GD, Fiardalisi I. Physiologic management of diabetic ketoacidemia. A 5-year prospective pediatric experience in 231 episodes. Arch Pediatr Adolesc Med 1994;148:1046-52.
29. Feiner EI, White PC. Improving management of diabetic ketoacidasis in children. Pediatrics 2001;108:735-40.
30. Atluru VL. Spontaneous intracerebral hematomas in juvenile diabetic ketoacidosis. Pediatr Neural 1986;2:167-9.
31. Kanter RK, et al. Arterial thrombosis causing cerebral edema in association with diabetic ketoacidosis. Crit Care Med 1987;15:175-6.
32. Moll GW Jr, et al. Rhinocerebral mucarmycasis in IDDM. Sequential magnetic resonace imaging af long-term survival with intensive therapy. Diabetes Care 1994;17:1348-53.
33. Young MC. Simultaneous acute cerebral and pulmonary edema complicating diabetic ketoacidosis. Diabetes Care 1995;18:1288-90.
34. Breidbart S, et al. Adult respiratory distress syndrome in an adolescent with diabetic ketoacidosis. J Pediatr 1987;111:736-8.
35. Watson JP, Bamett AH. Pneumomediastinum in diabetic ketoacidosis. Diabet Med 1989;6:173-4.
36. Cateels K, et al. Rhabdomyolysis in diabetic ketoacidosis. Pediatric Diabetes 2003;4:29-31.
37. Tubtona-Rufi N, Thizon-de Gaulle I, Czernichow P. Hypothalamopituitary deficiency and precocious puberty following hyperhyaration in diabetic ketoacidosis. Horm Res 1992;37:60-3.
38. Lufkin EG, et al. Acute cerebral dysfunction in diabetic ketoacidosis: survival followed by panhypopituitarism. Metabolism 1977;26:363-9.
39. Keller RJ, Wolfsdorf JI. Isolated growth hormone deficiency after cerebral edema complicating diabetic ketoacidosis. N Engl J Med 1987;316:857-9.
40. Dunlop KA, Woodman D, Carson DJ. Hypopituitarism following cerebral oedema with diabetic ketoacidosis. Arch Dis Child 2002;87:337-8.
41. Edge JA. Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer finding a cause? Diabetes Metab Res Rev 2000;16:316-24.
42. Deeb L. Development of fatal cerebral oedema during outpatient therapy for diabetic ketoacidosis. Pract Diab 1989;6:212-13.
43. Glasgow AM. Devastating cerebral edema in diabetic ketoacidosis before therapy. Diabetes Care 1991;14:77-8.
44. Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990;13:22-33.
45. Muir A. Therapeutic controversy. Cerebral edema in diabetic ketoacidosis: a look beyond rehydration. J Clin Endocrinol Metab 2000;85:509-13.
46. Abbott NJ. Inflammatory mediators and modulation of blood-brain barrier permeability. Cell Mol Neurobiol 2000;20:131-47.
47. Sarker MH, Fraser PA. The role of guanylyl cyclases in the permeability response to inflammatory mediators in pial venular capillaries in the rat. J Physiol 2002;540(pt 1):209-18.
48. Yang GY, Betz AL. Reperfusion-induced injury to the blood-brain barrier after middle cerebral artery occlusion in rats. Stroke 1994;25:1658-65.
49. O'Donnell ME, Martinez A, Sun D. Endothelial Na-K-Cl cotransport regulation by tonicity and hormones: phosphorylation of cotransport protein. Am J Physiol 1995;269(6 pt 1):C1513-23.
50. Kimelberg HK, et al. Astrocytic swelling due to hypotonic or high K+ medium causes inhibition of glutamate and aspartate uptake and increases their release. J Cereb Blood Flow Metab 1995;15:409-16.
51. Manley GT, et al. Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke. Nat Med 2000;6:159-63.
52. McManus ML, Churchwell KB, Strange K. Regulation of cell volume in health and disease. N Engl J Med 1995;333:1260-6.
53. Krane EJ, et al. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med 1985;312:1147-51.
54. Hoffman WH, et al. Cranial CT in children and adolescents with diabetic ketoacidosis. AJNR Am J Neuroradiol 1988;9:733-9.
55. Hoffman WH, et al. Computer analysis of magnetic resonance imaging of the brain in children and adolescents after treatment of diabetic ketoacidosis. J Diabetes Complications 1999;13:176-81.
56. Hoffman WH, et al. Transcranial Doppler ultrasound assessment of intracranial hemodynamics in children with diabetic ketoacidosis. J Clin Ultrasound 1995;23:517-23.
57. Harris GD, et al. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study [published erratum appears in J Pediatr 1991;118:166-7]. J Pediatr 1990;117(1 pt 1):22-31.
58. Harris GD, et al. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study [published erratum appears in J Pediatr 1991;118:166-7]. J Pediatr 1990;117(1 pt 1):22-31.
59. Hole PM, et al. Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes. Acta Paediatr 1997;86:626-31.
60. Mel JM, Werther GA. Incidence and outcome of diabetic cerebral oedema in childhood: are there predictors? J Paediatr Child Health 1995;31:17-20.
61. Durr JA, et al. Correlates of brain edema in uncontrolled IDDM. Diabetes 1992;41:627-32.
62. Bureau MA, et al. Cerebral hypoxia from bicarbonate infusion in diabetic acidosis. J Pediatr 1980;96:968-73.
63. Roberts I, Shhierhout G. Hyperventilation therapy for acute traumatic brain injury (Cochrane review). The Cochrane Library 2003.
64. Bonadio WA, et al. Outpatient management of diabetic ketoacidosis. Am J Dis Child 1988;142:448-50.
65. Linares MY, Schunk JE, Lindsay R. Laboratory presentation in diabetic ketoacidosis and duration of therapy. Pediatr Emerg Care 1996;12:347-51.
66. Monroe KW, King W, Atchison JA. Use of PRISM scores in triage of pediatric patients with diabetic ketoacidosis. Am J Manag Care 1997;3:253-8.
67. Atchley D, Loeb R, Richards D. On diabetic acidosis. A detailed study of electrolyte balances following withdrawal and reestablishment of therapy. J Clin Invest 1933;12:297-326.
68. Nabarro JDN, Spencer AG, Stowers JM. Metabolic studies in severe diabetic ketosis. Q J Med 1952;82:225-48.
69. Mackenzie A, Barnes G, Shann F. Clinical signs of dehydration in children. Lancet 1989;2:605-7.
70. Waldhausl W, et al. Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration. Diabetes 1979;28:577-84.
71. Owen OE, Licht JH, Sapir DG. Renal function and effects of partial rehydration during diabetic ketoacidosis. Diabetes 1981;30:510-18.
72. Harris GD, Fiordalisi I, Yu C. Maintaining normal intracranial pressure in a rabbit model during treatment of severe diabetic ketoacidemia. Life Sci 1996;59:1695-702.
73. Clements RS Jr, et al. Increased cerebrospinal-fluid pressure during treatment of diabetic ketosis. Lancet 1971;2:671-5.
74. Adrogue HJ, Barrero J, Eknoyan G. Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. Use in patients without extreme volume deficit. JAMA 1989;262:2108-13.
75. Adrogue HJ, Eknoyan G, Suki WK. Diabetic ketoacidosis: role of the kidney in the acid-bose homeostasis re-evaluated. Kidney Int 1984;25:591-8.
76. Oh MS, Carroll HJ, Uribarri J. Mechanism of normochloremic and hyperchloremic acidosis in diabetic ketoacidosis: Nephron 1990;54:1-6.
77. Kitabchi AE. Low-dose insulin therapy in diabetic ketoacidosis: fact or fiction? Diabetes Metab Rev 1989;5:337-63.
78. Schade DS, Eaton RP. Dose response to insulin in man: differential effects on glucose and ketone body regulation. J Clin Endocrinol Metab 1977;44:1038-53.
79. Luzi L, et al. Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes 1988;37:1470-7.
80. Soler NG, et al. Comparative study of different insulin regimens in management of diabetic ketoacidosis. Lancet 1975;2:1221-4.
81. Fort P, Waters SM, Lifshitz F. Low-dose insulin infusion in the treatment of diabetic ketoacidosis: bolus versus no bolus. J Pediatr 1980;96:36-40.
82. Lindsay R, Bolte RG. The use of an insulin bolus in low-dose insulin infusion for pediatric diabetic ketoacidosis. Pediatr Emerg Care 1989;5:77-9.
83. Nabarro J, Spencer A, Stowers J. Treatment of diabetic ketoacidosis. Lancet 1952;i:983.
84. Danowski T, Peters J. Studies in diabetic acidosis and coma, with particular emphasis on the retention of administered potassium. J Clin Invest 1949;28:1-9.
85. Butler A, Talbot N. Metabolic studies in diabetic coma. Trans Assoc Am Physicians 1947;60:102-9.
86. Darrow DC, Pratt EL. Retention of water and electrolyte during recovery in a patient with diabetic acidosis. J Pediatr 1952;41:688-96.
87. Adrogue HJ, et al. Determinants of plasma potassium levels in diabetic ketoacidosis. Medicine (Baltimore) 1986;65:163-72.
88. Riley MS, Schade DS, Eaton RP. Effects of insulin infusion on plasma phosphate in diabetic patients. Metabolism 1979;28:191-4.
89. Alberti KG, et al. 2,3-Diphosphoglycerate and tissue oxygenation in uncontrolled diabetes mellitus. Lancet 1972;2:391-5.
90. Gibby OM, et al. Oxygen availability from the blood and the effect of phosphate replacement on erythrocyte 2,3-diphosphoglycerate and haemoglobin-oxygen affinity in diabetic ketoacidosis. Diabetologia 1978;15:381-5.
91. Keller U, Berger W. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetes 1980;29:87-95.
92. Wilson HK, et al. Phosphate therapy in diabetic ketoacidosis. Arch Intern Med 1982;142:517-20.
93. Becker DJ, et al. Phosphate replacement during treatment of diabetic ketosis. Effects on calcium and phosphorus homeostasis. Am J Dis Child 1983;137:241-6.
94. Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab 1983;57:177-80.
95. Clerbaux T, et al. Effect of phosphate on oxygen-hemoglobin affinity, diphosphoglycerate and blood gases during recovery from diabetic ketoacidosis. Intensive Care Med 1989;15:495-8.
96. Winter RJ, et al. Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med 1979;67:897-900.
97. Zipf WB, et al. Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Diabetes Care 1979;2:265-8.
98. Soler NG, et al. Potassium balance during treatment of diabetic ketoacidosis with special reference to the use of bicarbonate. Lancet 1972;2:665-7.
99. Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. BMJ 1984;289:1035-8.
100. Okuda Y, et al. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab 1996;81:314-20.
101. Green SM, et al. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med 1998;31:41-8.
102. Ohman JL Jr, et al. The cerebrospinal fluid in diabetic ketoacidosis. N Engl J Med 1971;284:283-90.
103. Assal JP, et al. Metabolic effects of sodium bicarbonate in management of diabetic ketoacidosis. Diabetes 1974;23:405-11.
104. Franklin B, Liu J, Ginsberg-Fellner F. Cerebral edema and ophthalmoplegia reversed by mannitol in a new case of insulin-dependent diabetes mellitus. Pediatrics 1982;69:87-90.
105. Shabbir N, et al. Recovery from symptomatic brain swelling in diabetic ketoacidosis. Clin Pediatr (Phila) 1992;31:570-3.
106. Roberts MD, Slover R, Chase HP. Diabetic ketoacidosis with intracerebral complications. Pediatr Diabetes 2001;2:109-14.
107. Marcin JP, et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. J Pediatr 2002;141:793-7.
108. Kamat P, et al. Use of hypertonic saline for the treatment of altered mental status associated with diabetic ketoacidosis. Pediatr Crit Care Med 2003;4:239-42.
109. Diabetes Prevention Trial - Type 1 Diabetes Study Group. Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med 2002;346:1685-91.
110. Levy-Marchal C, Patterson CC, Green A. Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and Diabetes. Diabetologia 2001;44(suppl 3):B75-80.
111. Vanelli M, et al. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care 1999;22:7-9.
112. Grey M, et al. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr 2000;137:107-13.
113. Drozda DJ, et al. Assessment of the effect of a comprehensive diabetes management program on hospital admission rates of children with diabetes mellitus. Diabetes Educ 1990;16:389-93.
114. Malone JI, Root AW. Plasma free insulin concentrations: keystone to effective management of diabetes mellitus in children. J Pediatr 1981;99:862-7.