الفهرس 
DKA in pediatricsOnly 14 pages are availabe for public view
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Abstract
Diabetic ketoacidosis (DKA) is a life threatening
condition that frequently requires hospitalization in children
with diabetes. It results from relative or absolute insulin
deficiency and the unopposed action of counter-regulatory
hormones, and is usually consists of hyperglycemia,
ketonemia, and metabolic acidosis.
The patient is usually presented with polyuria,
polydipsia, enuresis, weight loss and polyphagia that
characterize DM. When it progresses to DKA, there are
nausea, vomiting, progressive anorexia, abdominal pain,
fatigue headache, restlessness, irritability and dehydration.
Most of patients have electrolyte imbalance including serum
sodium, potassium, magnesium, and phosphorus.
The goals of therapy in DKA include fluid repletion,
correction of dehydration, correction of acidosis and
reversal of ketosis, correction of electrolyte disturbances,
restoration of blood glucose to near normal and prevention
of recurrent episodes.
The most serious complication of DKA is cerebral
edema which occurs in about 1% of children with DKA and
has a mortality rate of 20 % to 90 % of cases.
Possible mechanisms for DKA- CE can be grouped
into five general theories. Each of these theories seems to
hold true for some, but not all cases of CE-DKA; the
hydrostatic /osmotic gradient theory, the blood brain barrier
permeability theory, the ischemia/hypoxia theory, volume
Summary
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regulation failure theory, and acidosis theory. Moreover,
many of these theories overlap, which suggests that multiple
mechanisms could converge and result in symptomatic
DKA– CE Clinical diagnosis of DKA– CE includes minor,
major, and diagnostic criteria.
Major criteria include: Altered mentation / fluctuating
level of consciousness,sustained heart rate deceleration not
attributable to improved intravascular volume or sleep state,
and age-inappropriate incontinence.
Minor criteria include : Vomiting, headache, lethargy
or not easily aroused from sleep, diastolic blood pressure
>90 mmHg, and age less than 5 years.
Diagnostic criteria include : Abnormal motor or
verbal response to pain, decorticate or decerebrate posture,
cranial nerve palsy, and abnormal neurogenic respiratory
pattern.
To confirm diagnosis of CE-DKA; one diagnostic
criterion, two major criteria, or one major and two minor
criteria must be present.
Treatment include reducing the rate of fluid
administration, use of mannitol, hypertonic saline,
intubation and hyperventilation, and intracranial pressure
(ICP) monitoring.
Certainly the best way to prevent CE-DKA is to
prevent DKA.Once DKA occurs; cautious administration of
fluid, insulin, and sodium bicarbonate and correction of
electrolyte abnormalities should be done as they relate to
prevention of cerebral edema.