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Emergency Medical Minute


Nov 23, 2020

Contributor: Ryan Circh, MD

Educational Pearls:

  • Diabetic ketoacidosis (DKA) can be the initial presenting condition of undiagnosed diabetes type I in pediatric patients
  • Unlike adults, children typically need less fluid (i.e. 10 mL/kg bolus for those in shock followed by maintenance)
  • Cerebral edema is a concern from rapid administration of fluids
  • An insulin drip at 0.1 units/Kg/hr should be started but a bolus isn’t required

Editor’s note: While conceptually similar, treatment for pediatric DKA is overall less aggressive (no bolus of insulin, less fluids, slower corrections, etc.). Recent literature also continues to argue against cerebral edema being related to fluid management


Hsia D, Tarai S, Alimi A, Coss-Bu J, Haymond M. Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema. Pediatr Diabetes. 2015;16(5):338-344. 

Wolfsdorf J, Glaser N, Sperling M, American D. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(5):1150-1159.

Olivieri L, Chasm R. Diabetic ketoacidosis in the pediatric emergency department. Emerg Med Clin North Am. 2013 Aug;31(3):755-73. doi: 10.1016/j.emc.2013.05.004. Epub 2013 Jul 6. PMID: 23915602.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD


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