Child Health/Paediatric DKA

Paediatric DKA management

also: diabetic ketoacidosis children · cerebral oedema · fixed-rate insulin

Overview

Paediatric DKA differs from adult — the danger is CEREBRAL OEDEMA, so fluids are given cautiously and insulin is started AFTER fluids, with no bolus.

Mechanism

Insulin switches off ketogenesis and lowers glucose; careful fluid replacement corrects the deficit. In children, over-rapid fluid/osmolar shifts precipitate cerebral oedema — hence cautious fluids, delayed insulin, and no bolus.

Indications

Diabetic ketoacidosis in children (glucose >11, pH <7.3/bicarb <15, ketones)

The agents

IV fluids (cautious)first

calculated deficit over 48 h

0.9% saline; avoid over-rapid correction (cerebral oedema).

Fixed-rate insulin infusion0.05–0.1 U/kg/h

start 1–2 h AFTER fluids

NO insulin bolus in children (cerebral oedema risk).

Potassiumadded once <5.5 + urine

Insulin drives K⁺ into cells → hypokalaemia.

Adverse effects

Cerebral oedemaserious

Leading cause of death in paediatric DKA — headache, ↓GCS, bradycardia/hypertension → mannitol/hypertonic saline.

Hypokalaemiaserious

Hypoglycaemia (add glucose when BG <14)common

Cautions & contraindications

Insulin bolus / over-rapid fluids in childrenpaediatric

Cerebral oedema.

Interactions

Monitoring & kinetics

Hourly glucose/ketones, U&E, neuro obs (cerebral oedema), ECG (K⁺)

IV. Fluids first, then fixed-rate insulin; switch to SC insulin once resolved + eating.

Choosing it

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Source: BSPED — Paediatric DKA · NICE NG18 — Diabetes in children