Key Learning Points

  • The risk of DKA in established T1DM is 1-10% per patient per year (A, C)
  • Risk factors include children who omit insulin and those on insulin pump therapy (C)
  • Children with severe DKA or those at increased risk of cerebral oedema should be considered for treatment in an intensive care setting (C)
  • All children with DKA should receive a fluid bolus, the volume of which should be based on whether they are clinically shocked (E)
  • Water and salt deficits should be replaced (A) over 48 hours (C) with crystalloid rather than colloid (E)
  • Insulin is required to normalise blood glucose & suppress ketogenesis (A). An IV infusion (A) should be started at least 1 hour after starting fluid replacement therapy (C, E)
  • Potassium replacement therapy should be commenced regardless of serum concentration (A) at a concentration of 40mmol/L (i.e. 20mmol in 500ml)(E)
  • There is no clinical benefit in routine bicarbonate (B, C) or phosphate (A) replacement
  • Risk factors for cerebral oedema include young age, new onset T1DM, longer duration of symptoms, severe acidosis & bicarbonate correction (C)
  • Suspected cerebral oedema should be treated with hypertonic saline (C) or mannitol (C, E)
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