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1 Pitfalls in management of diabetic ketoacidosis (DKA)
  1. Sabine Hofer
  1. Department für Pädiatrie, Medizinische Universität Innsbruck, Austria


Diabetic Ketoacidosis is known as acute complication of diabetes occurring in a high percentage of patients at disease onset- frequency varies worldwide from 15% to 70% – with higher risk in very young children and in children of ethnic minority groups as well as families with reduced access to medical care. Furthermore, this acute diabetes complication can also occur at any time during disease based on insulin deficiency. In children with established diabetes risk factors for DKA are poor metabolic control, omission of insulin, gastroenteritis and vomiting, psychiatric disorders and eating disorders, unstable family circumstances and risk behaviour during puberty. Additionally, during Covid-Pandemic a worldwide increase of DKA has been reported.

Clinical signs of diabetic ketoacidosis include dehydration, nausea, vomiting, abdominal pain, tachycardia and tachypnoe, deep respiration, drowsiness, confusion and progressive decrease in level of consciousness.

The management of DKA and/or the hyperglycemic hyperosmolar state (HHS) includes intravenous rehydration and correction of electrolyte disturbances, insulin replacement and clinical and biochemical monitoring throughout the DKA episode. Simple, clear and effective algorithms for the management of DKA need to be established at every department of paediatrics.

During treatment of DKA several complications can occur. Watch out for neurological deteriorations as a sign of severe complications during DKA. Cerebral injury (CI) – formerly cerebral edema – may occur at any stage of DKA. Symptoms of CI include headache, change in neurological status followed by high blood pressure, bradycardia, respiratory suppression. Be aware of other complications of DKA during treatment like hypopotassiaemia, hyperchloremic acidosis, hyperglycemic hyperosmolar state and inadequate rehydration but also hypoglycaemia during insulin infusion.

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