ABSTRACT
Diabetic ketoacidosis (DKA) is a medical emergency of hyperglycemia, metabolic acidosis, and hyperketonemia. Laboratory assessment of DKA includes testing for increased production of ketone bodies: ß-hydroxybutyric acid, acetoacetic acid, and acetone. DKA treatment requires close monitoring with every 1-hour glucose measurement and every 2-hour electrolytes, including measurement of anion gap. Some advocate that if, following DKA resolution, a hyperchloremic, non-anion gap metabolic acidosis exists, then sodium bicarbonate infusion should be instituted to hasten replenishment of serum bicarbonate and restore acid-base homeostasis. Children undergoing treatment for DKA are at elevated risk for cerebral edema with high mortality. Pathophysiology likely involves ischemia/reperfusion injury and inflammation. Risk for cerebral edema in children has been associated with sodium bicarbonate treatment such that it is not recommended in treatment of pediatric DKA. Abdominal pain, nausea, and vomiting are common complaints on presentation with DKA, and = 25% of patients will have amylase and lipase elevations.
