Treatment of Pediatric Diabetic Ketoacidosis in Canada: A Review of Treatment Protocols from Canadian Pediatric Emergency Departments

Abstract

Objective: Diabetes is the most common pediatric endocrine disorder, and diabetic ketoacidosis (DKA) is the leading cause of diabetes-related morbidity and mortality. This article reviews pediatric DKA treatment protocols from across Canada and identifies similarities and differences. Methods: Pediatric tertiary centres in Canada were asked for a copy of their DKA treatment protocol. For each protocol, we collected information on the amount of initial fluid bolus, maintenance fluid rate, insulin infusion rate, potassium replacement, monitoring and adjustment for serum glucose, administration of bicarbonate, and treatment for cerebral edema. Results: Responses were obtained from 13 sites. Treatment guidelines were consistent in their recommendations on timing and dosage of intravenous insulin, potassium replacement, monitoring and adjusting for serum glucose, and management of cerebral edema. Variability in treatment protocols was found chiefly in volume of initial fluid bolus (range: 5-20 mL/kg) and length of time boluses should be administered (20-120 min), maintenance fluid rates (based on weight or a 48-hr deficit), and the role of bicarbonate administration. Conclusions: This is the first review of treatment protocols for pediatric DKA in Canada. It identified many common approaches but noted specific differences in fluid boluses, maintenance fluid rates, and bicarbonate administration. The extent of variation indicates the need for further study, as well as national guidelines that are evidence-based and consistent with best practices.

Bicarbonate correction of ketoacidosis alters host-pathogen interactions and alleviates mucormycosis

“…Currently, diabetics with ketoacidosis are treated with glucose and insulin. The American, Canadian, and British guidelines for treatment of ketoacidosis reserve NaHCO 3 treatment only for those in severe acidosis (e.g., pH <6.9) (6, [24][25][26]. The findings in this experimental model strongly suggest that patients with ketoacidosis plus mucormycosis may benefit by earlier treatment with NaHCO 3 .…”

Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

“…Ketoacidosis is a serious complication of T1DM and the leading cause of diabetes-related deaths, mainly due to cerebral edema that occurs in 0.4% -3.1% of patients (1)(2)(3). It also accounts for a large proportion of diabetes-related hospitalizations (4,5).…”

Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

“…This difference in management of DKA in the pediatric population has been seen in other areas as well. Skitch and Valani[23] looked at the protocols of thirteen pediatric tertiary centers in Canada and reported many differences in the management of DKA. In comparison, a survey in pediatric centers in the Italian Society for Pediatric Diabetology and Endocrinology recognized significant differences in DKA management among their centers as well[24].…”

“…In comparison, a survey in pediatric centers in the Italian Society for Pediatric Diabetology and Endocrinology recognized significant differences in DKA management among their centers as well[24]. Both articles reference the need for evidence-based guidelines to be utilized across the board for best practice[23,24]. Although, DKA is managed through different methods, preventative care for these patients is of utmost importance.…”