Therapy of Diabetic Ketoacidosis

Czech version

Authors: D. Csomor ¹; T. Šagát ¹; D. Karovič ³; Ľ. Barák ²; E. Jančová ²; J. Staník ²; M. Benedeková ²; H. Trimmel ³; P. Gašparec ¹; R. Riedel ¹
Authors‘ workplace: Detská klinika anestéziológie a intenzívnej medicíny pri Slovenskej zdravotníckej univerzite a Detskej ; fakultnej nemocnici s poliklinikou, Bratislava prednosta kliniky prof. MUDr. T. Šagát, CSc. I. detská klinika Lekárskej fakulty Univerzity Komenského a Detskej fakultnej nemocnice s poliklinikou ¹; Bratislava prednostka kliniky doc. MUDr. M. Benedeková, PhD., mim. prof. ²; Oddelenie anestézie, intenzívnej a urgentnej medicíny, AKH Wiener Neustadt, Rakúsko vedúci oddelenia Dr. med. H. Trimmel ³
Published in: Čes-slov Pediat 2006; 61 (10): 603-609.
Category: Comprehensive Report

Overview

The cause of brain oedema in diabetic ketoacidosis in children has not been clarified yet. It has not been proved whether there is a iatrogenic damage induced by high doses of insulin, administration of bicarbonate or the large volume of hypotonic solution. Likewise, there is no evidence of hypoxic hypothesis on the basis of brain vasoconstriction in compensation of diabetic metabolic acidosis by hyperventilation with subsequent hypocapnia. It is therefore impossible to exclude idiosyncratic reaction of the organism, although it is difficult to expect also for the fact that the development of brain oedema most frequently occurs during the first manifestation of diabetes. Most authors agree that the risk of brain oedema development can be decreased by strict individualization of therapy with gradual adjustment of osmolality, which in the hypovolemic shock is preceded by volume resuscitation. In general it is recommended to decrease glycemia by ≤4–5 mmol/l/h, to adjust hyponatremia by 0.5–2 mmol/l/h (≤15–20 mmol/l/day) and to decrease osmolality by ≤30–40 mOsm/day (the risk decrease is by >3 mOsm/kg/h). The authors describe the therapeutic procedure in diabetic ketoacidosis, having been used at their workplace.

Key words:
diabetic ketoacidosis (DKA), children, brain oedema in diabetic ketoacidosis, procedure, therapy