الفهرس 
Diabetic Ketoacidosis 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 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.