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Diabetic Ketoacidosis in Children and the Role of Outpatient Management

H. Peter Chase MD1
Satish K. Garg MD2
David H. Jelley MD3
 1 Professor of Pediatrics, University of Colorado Health Sciences Center, Clinical Director, Barbara Davis Center for Childhood Diabetes, 4200 East 9th Ave, Box B-140, Denver, CO 80262
2 Visiting Professor of Pediatrics, University of Colorado Health Sciences Center, Denver, CO.
3 Fellow, Division of Diabetes and Endocrinology, University of Colorado Health Sciences Center, Denver, CO.

Diabetic ketoacidosis (DKA) is a common complication among children with diabetes, accounting for 14% to 31% of all diabetes-related hospital admissions.1,2 Extrapolation of data from the National Commission on Diabetes3 suggests that there are approximately 160 000 admissions to private hospitals each year in the United States for DKA. The cost of hospitalizations for DKA is over one billion dollars annually. Sixty-five percent of all patients admitted are less than 19 years of age. The incidence of DKA is believed to be declining. However, because the numbers of subjects with insulin-dependent diabetes mellitus is increasing, the absolute number of hospitalizations for DKA is still increasing. It is the single most common cause of death in diabetic patients under 24 years of age.2

The treatment of DKA has changed in recent years, particularly with the use of low-dose continuous intravenous insulin infusion and with the availability of blood pH levels. Severe DKA has been defined as "a state of ketoacidosis with serum bicarbonate decreased to 10 mmol/L or less," or more recently, as a "pH of 7.1 or less."4 The mortality from DKA has been reported to be in the range of 0.5 to 15.4%.3,5 Previous mortality figures were as high as 38%.2




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