Individual Approach to Treatment of Diabetic Ketoacidosis

Overview

10 - 40% children with newly diagnosed diabetes are admited to hospital in a state of diabetic ketoacidosis the mortality of which in advanced countries is 1 - 2%. Successful control of the acute condition depends on adequate insulin and potassium doses in a continuous infusion and prevention of cerebral oedema.The need of insulin and potassium during the initial 48 hours of treatment was analyzed in 26 children with a recent manifestation of diabetes type 1. The children age was 1.0 - 16.5 years (median 10.2). Treatment was administered according to a standard protocol. The baseline blood sugar level of the patients was 13.9 - 43.0 mmol/l (median 27.1), the potassium level 3.2 - 6.8 mmol/l (median 4.6), the CHO3- level 4.7 - 30.5 mmol/l (median 16.2) and HbA1c 7.1 - 14.5% (median 9.4). The insulin requirement remained stable (1st to 24th and 25th to 48th hour of treatment - median 0.06 I.V./kg/hour). The potassium requirement declined significantly from 4.6 mmol/kg/24 hours (median) during the 1st to 24th hour to 3.6 mmol/kg/hours during the 25th to 48th hour of treatment. The individual insulin requirement was influenced by the severity of the baseline acidosis which was expressed by the HCO3- level (1st to 24th hour, r=0.71, p

Key words:
diabetes mellitus type 1, diabetic ketoacidosis, treatment, children, insulin, potassium