Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Piva, Jefferson Pedro; Czepielewski, Mauro Antônio; García, Pedro Celiny Ramos

doi:10.1590/s0021-75572007000700002

Cited by 5 publications

(2 citation statements)

References 17 publications

(43 reference statements)

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“…In general, there is also a depletion of total-body phosphate related to osmotic diuresis too, and an accentuated fall in its serum levels is observed after starting insulin replacement, which provokes a rapid intracellular shift of phosphate [12,17]. …”

Section: Dka: Pathophysiology Clinical Condition and Treatmentmentioning

confidence: 99%

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Savoldelli

Farhat

Manna

2010

Diabetol Metab Syndr

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DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.

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Section: Dka: Pathophysiology Clinical Condition and Treatmentmentioning

confidence: 99%

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Savoldelli

Farhat

Manna

2010

Diabetol Metab Syndr

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“…Se a redução de glicemia for mais rápida que 100 mg/dL/h, na vigência de infusão contínua, deve-se aumentar a administração de glicose endovenosa, podendo chegar até 5 mg/kg/min. A redução da infusão de insulina contínua somente pode ocorrer quando houver necessidade de infusão de glicose acima de 5 mg/kg/min para manter glicemia entre 150 e 200 mg/dL, reduzindo, assim, a taxa de infusão de insulina para 0,05 U/kg/h, mantendo a infusão de glicose entre 3,5 e 5 mg/kg/min (Dunger et al, 2004;Felner & White, 2001;Piva et al, 2007).…”

Section: Discussionunclassified

Manejo da cetoacidose diabética: um estudo de caso

Ferregato

Almeida²,

Oliveira³

et al. 2022

RSD

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Objetivo: Relatar o manejo clínico de um paciente com Cetoacidose Diabética (CAD), a partir de revisão de literatura sobre o tema. Métodos: Estudo de caso, com análise em protocolos de tratamento da correlação da eficácia da correção de Cetoacidose com a incidência de complicações secundárias ao respectivo tratamento, em um paciente internado em Unidade Pediátrica. Resultados: O paciente apresentou-se com CAD em primo-descompensação. A velocidade de redução da glicemia na 1ª hora foi superior a 100 mg/dL/hora, não sendo encontrado os dados de HGT das horas subsequentes até a 8ª hora de tratamento no prontuário. Foram utilizadas concentrações variáveis de glicose e potássio no plano para necessidades básicas de água e eletrólitos durante as primeiras 24 horas. A infusão de insulina intermediária NPH iniciou-se 36 horas após o início do tratamento. Em se tratando dos dados relativos às complicações, observou-se que o paciente apresentou hipoglicemia, hipopotassemia, persistência de acidose metabólica por suspensão precoce de infusão de insulina regular, com posterior alcalose por uso de bicarbonato na correção da acidose Conclusão: Após levantamento e análise de dados à luz do marco teórico de referência, observou-se a não existência de um protocolo específico para tratamento de CAD no serviço em estudo, sendo que o uso desses protocolos auxiliam no tratamento adequado da complicação aguda do diabetes, o que evita um risco maior de complicações e reduz a morbimortalidade.

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Diabetic Ketoacidosis

Piva

García

Branco

2014

Pediatric Critical Care Medicine

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The current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema are reviewed in this chapter. Based on the reviewed literature and on the author's experience, the most effi cient and recommended measures for DKA management are presented.Among the main fi ndings we would remark: (a) Normal saline solution (NaCl 0.9 %) remains as the preferred hydration solution. Hypotonic (diluted) solutions are avoided in the treatment of DKA. (b) there is a consensus regarding the contraindication of sodium bicarbonate administration to repair metabolic acidosis in DKA. (c) Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. In small babies with KAD and new onset diabetes, low insulin infusion rates (0.05 IU/kg/h) has been associated with few hypoglycemic episodes as well as with lower impact on the osmolarity, being protective for cerebral edema; (d) For fast corrections of glucose oscillations during DKA treatment, a practical scheme using two bags of electrolytic solutions is presented. (e) Cerebral edema, associated with DKA is a multifactorial process with different pathophysiological mechanisms. Depending on the associated risk for cerebral edema the most efficient treatment measures are reviewed.In conclusion: continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.

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Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Cited by 5 publications

References 17 publications

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Manejo da cetoacidose diabética: um estudo de caso

Diabetic Ketoacidosis

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