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Pediatric diabetic ketoacidosis (DKA) accounts for 15% of all diabetes-related hospital admissions. A retrospective study of 63 emergency department cases of Type 1 diabetic patients treated for DKA was performed to determine characteristics of patients who may be managed safely as outpatients. All patients were treated in the ED for a maximum of three hours with standard rehydration and insulin supplementation. Thirty-six patients had complete resolution of physical findings (except otitis media) and metabolic acidosis (bicarbonate > 20 mEq/L or pH > 7.35) within this period and were discharged with close follow-up. One patient required retreatment in the ED within 48 hours. Of the 27 who did not resolve within three hours (admitted for inpatient therapy), 22 had both an initial bicarbonate less than 10 mEq/L and pH less than 7.20. It is recommended that pediatric diabetic patients in DKA with an initial bicarbonate of more than 10 mEq/L or pH above 7.20 be treated in the ED for a period not to exceed three hours. If there is resolution of metabolic acidosis and clinical resolution with ability to tolerate feeding, outpatient therapy with close follow-up is indicated. Bruce Spears

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Author

Robin Nicholson

Publisher

Elsevier Science; Elsevier ; Mosby Inc.; Elsevier BV (ISSN 1097-6760)

Published

1989

Language

EN

Field

Medicine (Health Sciences)