The International Society of Pediatric and Adolescent Diabetes guidelines for management of diabetic ketoacidosis: Do the guidelines need to be modified?

Pediatric Diabetes

Volumn 15, Issue 4, 2014, Pages 277-286

  Wolfsdorf, Joseph I ^a,b  

^a BOSTON CHILDREN S HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

Author keywords

Diabetes; Diabetic ketoacidosis; Management guidelines

Indexed keywords

3 HYDROXYBUTYRIC ACID; GLUCOSE; INSULIN; PIG INSULIN; SODIUM CHLORIDE; WATER; ANTIDIABETIC AGENT;

ADOLESCENT DISEASE; BRAIN EDEMA; CHILDHOOD DISEASE; CONSENSUS; DEHYDRATION; DIABETES CONTROL; DIABETIC KETOACIDOSIS; FLUID THERAPY; GLUCOSE BLOOD LEVEL; HUMAN; HYPERGLYCEMIA; HYPOGLYCEMIA; INSULIN INFUSION; INSULIN TREATMENT; MEDICAL SOCIETY; PRACTICE GUIDELINE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SALT REPLACEMENT; SUBSTITUTION THERAPY; WATER REPLACEMENT; ADOLESCENT; BLOOD; CHILD; COMPLICATION; DRUG MONITORING; EVIDENCE BASED MEDICINE; HEALTH CARE ORGANIZATION; HOSPITAL INFORMATION SYSTEM; INTERNATIONAL COOPERATION; MULTIMODALITY CANCER THERAPY; PRESCHOOL CHILD;

3-HYDROXYBUTYRIC ACID; ADOLESCENT; BRAIN EDEMA; CHILD; CHILD, PRESCHOOL; COMBINED MODALITY THERAPY; DIABETIC KETOACIDOSIS; DRUG MONITORING; EVIDENCE-BASED MEDICINE; FLUID THERAPY; HUMANS; HYPOGLYCEMIC AGENTS; INSULIN; INTERNATIONAL AGENCIES; POINT-OF-CARE SYSTEMS; PRACTICE GUIDELINES AS TOPIC; SOCIETIES, SCIENTIFIC;

EID: 84901458833     PISSN: 1399543X     EISSN: 13995448     Source Type: Journal    
DOI: 10.1111/pedi.12154     Document Type: Review

References (61)

1. Dunger DB, Sperling MA, Acerini CL et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2004: 89: 188-194.
2. Dunger DB, Sperling MA, Acerini CL et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004: 113: e133-e140.
3. Wolfsdorf J, Craig ME, Daneman D et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 2009: 10 (Suppl. 12): 118-133.
4. Marliss EB, Ohman JL Jr, Aoki TT, Kozak GP. Altered redox state obscuring ketoacidosis in diabetic patients with lactic acidosis. N Engl J Med 1970: 283: 978-980.
5. Lim KC, Walsh CH. Diabetic ketoalkalosis: a readily misdiagnosed entity. Br Med J 1976: 2: 19.
6. Goldstein DE, Little RR, Lorenz RA et al. Tests of glycemia in diabetes. Diabetes Care 2004: 27: 1761-1773.
7. Stephens JM, Sulway MJ, Watkins PJ. Relationship of blood acetoacetate and 3-hydroxybutyrate in diabetes. Diabetes 1971: 20: 485-489.
8. Sheikh-Ali M, Karon BS, Basu A et al. Can serum beta-hydroxybutyrate be used to diagnose diabetic ketoacidosis? Diabetes Care 2008: 31: 643-647.
9. Umpierrez GE, DiGirolamo M, Tuvlin JA, Isaacs SD, Bhoola SM, Kokko JP. Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis. J Crit Care 2000: 15: 52-59.
10. Kitabchi AE, Young R, Sacks H, Morris L. Diabetic ketoacidosis: reappraisal of therapeutic approach. Annu Rev Med 1979: 30: 339-357.
11. Miles JM, Gerich JE. Glucose and ketone body kinetics in diabetic ketoacidosis. Clin Endocrinol Metab 1983: 12: 303-319.
12. Halperin ML, Bear RA, Hannaford MC, Goldstein MB. Selected aspects of the pathophysiology of metabolic acidosis in diabetes mellitus. Diabetes 1981: 30: 781-787.
13. Rewers A, McFann K, Chase HP. Bedside monitoring of blood beta-hydroxybutyrate levels in the management of diabetic ketoacidosis in children. Diabetes Technol Ther 2006: 8: 671-676.
14. Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, Stentz FB. Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. J Clin Endocrinol Metab 2008: 93: 1541-1552.
15. Alberti KG, Hockaday TD, Turner RC. Small doses of intramuscular insulin in the treatment of diabetic 'coma'. Lancet 1973: 2: 515-522.
16. Wagner A, Risse A, Brill HL et al. Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application. Diabetes Care 1999: 22: 674-677.
17. Moseley J. Diabetic crises in children treated with small doses of intramuscular insulin. Br Med J 1975: 1: 59-61.
18. Martin MM, Martin AA. Continuous low-dose infusion of insulin in the treatment of diabetic ketoacidosis in children. J Pediatr 1976: 89: 560-564.
19. Veeser TE, Glines MH, Niederman LG, Monteleone JA. Low-dose intravenous insulin therapy for diabetic ketoacidosis in children. Am J Dis Child 1977: 131: 308-310.
20. Edwards GA, Kohaut EC, Wehring B, Hill LL. Effectiveness of low-dose continuous intravenous insulin infusion in diabetic ketoacidosis. A prospective comparative study. J Pediatr 1977: 91: 701-705.
21. Drop SL, Duval-Arnould JM, Gober AE, Hersh JH, McEnery PT, Knowles HC. Low-dose intravenous insulin infusion versus subcutaneous insulin injection: a controlled comparative study of diabetic ketoacidosis. Pediatrics 1977: 59: 733-738.
22. Burghen GA, Etteldorf JN, Fisher JN, Kitabchi AQ. Comparison of high-dose and low-dose insulin by continuous intravenous infusion in the treatment of diabetic ketoacidosis in children. Diabetes Care 1980: 3: 15-20.
23. Noyes KJ, Crofton P, Bath LE et al. Hydroxybutyrate near-patient testing to evaluate a new end-point for intravenous insulin therapy in the treatment of diabetic ketoacidosis in children. Pediatr Diabetes 2007: 8: 150-156.
24. Edge JA, Jakes RW, Roy Y et al. The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children. Diabetologia 2006: 49: 2002-2009.
25. Durr JA, Hoffman WH, Sklar AH, el Gammal T, Steinhart CM. Correlates of brain edema in uncontrolled IDDM. Diabetes 1992: 41: 627-632.
26. Glaser N, Barnett P, McCaslin I et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med 2001: 344: 264-269.
27. Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr 2005: 146: 688-692.
28. Harris GD, Fiordalisi I, Harris WL, Mosovich LL, Finberg L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study. J Pediatr 1990: 117: 22-31.
29. Carlotti AP, Bohn D, Halperin ML. Importance of timing of risk factors for cerebral oedema during therapy for diabetic ketoacidosis. Arch Dis Child 2003: 88: 170-173.
30. Hoorn EJ, Carlotti AP, Costa LA et al. Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis. J Pediatr 2007: 150: 467-473.
31. Puttha R, Cooke D, Subbarayan A et al. Low dose (0.05units/kg/h) is comparable with standard dose (0.1units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes-an observational study. Pediatr Diabetes 2010: 11: 12-17.
32. Al Hanshi S, Shann F. Insulin infused at 0.05 versus 0.1units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr Crit Care Med 2011: 12: 137-140.
33. Kapellen T, Vogel C, Telleis D, Siekmeyer M, Kiess W. Treatment of diabetic ketoacidosis (DKA) with 2 different regimens regarding fluid substitution and insulin dosage (0.025 vs. 0.1units/kg/h). Exp Clin Endocrinol Diabetes 2012: 120: 273-276.
34. Marcin JP, Kuppermann N, Tancredi DJ, Glaser NS. Insulin administration for treatment of pediatric diabetic ketoacidosis: are lower rates of infusion beneficial? Pediatr Crit Care Med 2011: 12: 217-219.
35. Glaser N. Cerebral injury and cerebral edema in children with diabetic ketoacidosis: could cerebral ischemia and reperfusion injury be involved? Pediatr Diabetes 2009: 10: 534-541.
36. Glaser NS, Wootton-Gorges SL, Buonocore MH et al. Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols. Pediatrics 2013: 131: e73-e80.
37. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001: 85: 16-22.
38. Krane EJ, Rockoff MA, Wallman JK, Wolfsdorf JI. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med 1985: 312: 1147-1151.
39. Hoffman WH, Steinhart CM, el Gammal T, Steele S, Cuadrado AR, Morse PK. Cranial CT in children and adolescents with diabetic ketoacidosis. AJNR Am J Neuroradiol 1988: 9: 733-739.
40. Glaser NS, Wootton-Gorges SL, Marcin JP et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004: 145: 164-171.
41. Glaser NS, Wootton-Gorges SL, Buonocore MH et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes 2006: 7: 75-80.
42. Arieff AI, Kleeman CR. Cerebral edema in diabetic comas. II. Effects of hyperosmolality, hyperglycemia and insulin in diabetic rabbits. J Clin Endocrinol Metab 1974: 38: 1057-1067.
43. Prockop LD. Hyperglycemia, polyol accumulation, and increased intracranial pressure. Arch Neurol 1971: 25: 126-140.
44. Duck SC, Wyatt DT. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 1988: 113: 10-14.
45. Harris GD, Fiordalisi I, Finberg L. Safe management of diabetic ketoacidemia. J Pediatr 1988: 113: 65-67.
46. Mahoney CP, Vlcek BW, DelAguila M. Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 1999: 21: 721-727.
47. Brown TB. Cerebral oedema in childhood diabetic ketoacidosis: is treatment a factor? Emerg Med J 2004: 21: 141-144.
48. Glaser NS, Marcin JP, Wootton-Gorges SL et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr 2008: 153: 541-546.
49. Glaser N, Yuen N, Anderson SE, Tancredi DJ, O'Donnell ME. Cerebral metabolic alterations in rats with diabetic ketoacidosis: effects of treatment with insulin and intravenous fluids and effects of bumetanide. Diabetes 2010: 59: 702-709.
50. Yuen N, Anderson SE, Glaser N, Tancredi DJ, O'Donnell ME. Cerebral blood flow and cerebral edema in rats with diabetic ketoacidosis. Diabetes 2008: 57: 2588-2594.
51. Glaser NS, Ghetti S, Casper TC, Dean JM, Kuppermann N. Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial. Pediatr Diabetes 2013: 14: 435-446.
52. Glaser NS, Kuppermann N, Yee CK, Schwartz DL, Styne DM. Variation in the management of pediatric diabetic ketoacidosis by specialty training. Arch Pediatr Adolesc Med 1997: 151: 1125-1132.
53. White PC, Dickson BA. Low morbidity and mortality in children with diabetic ketoacidosis treated with isotonic fluids. J Pediatr 2013: 163: 761-766.
54. Felner EI, White PC. Improving management of diabetic ketoacidosis in children. Pediatrics 2001: 108: 735-740.
55. Byrne HA, Tieszen KL, Hollis S, Dornan TL, New JP. Evaluation of an electrochemical sensor for measuring blood ketones. Diabetes Care 2000: 23: 500-503.
56. Laffel LM, Wentzell K, Loughlin C, Tovar A, Moltz K, Brink S. Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. Diabet Med 2006: 23: 278-284.
57. Klocker AA, Phelan H, Twigg SM, Craig ME. Blood beta-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in type 1 diabetes: a systematic review. Diabet Med 2013: 30: 818-824.
58. Ham MR, Okada P, White PC. Bedside ketone determination in diabetic children with hyperglycemia and ketosis in the acute care setting. Pediatr Diabetes 2004: 5: 39-43.
59. Yu HY, Agus M, Kellogg MD. Clinical utility of Abbott Precision Xceed Pro(R) ketone meter in diabetic patients. Pediatr Diabetes 2011: 12: 649-655.
60. Prisco F, Picardi A, Iafusco D et al. Blood ketone bodies in patients with recent-onset type 1 diabetes (a multicenter study). Pediatr Diabetes 2006: 7: 223-228.
61. Vanelli M, Chiari G, Capuano C, Iovane B, Bernardini A, Giacalone T. The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment. Diabetes Nutr Metab 2003: 16 (5-6): 312-316.