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November 2014

Insulin Therapy for the Management of Diabetic Ketoacidosis: Time for a Paradigm Shift?

Author Affiliations
  • 1Division of Pediatric Endocrinology, University of Michigan, Ann Arbor
  • 2Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor
JAMA Pediatr. 2014;168(11):990-991. doi:10.1001/jamapediatrics.2014.1635

Diabetic ketoacidosis (DKA) and cerebral edema are major causes of morbidity and mortality in children with diabetes mellitus.1,2 Despite greater awareness and reports of earlier detection, approximately one-third of US children with new-onset diabetes at the time of diagnosis present with DKA,3 which is defined by the presence of hyperglycemia (blood glucose [BG] level >200 mg/dL [to convert to millimoles per liter, multiply by 0.0555]), a venous pH less than 7.3 or a bicarbonate level less than 15 mEq/L (to convert to millimoles per liter, multiply by 1), and the presence of ketonemia or ketonuria.4 Initial therapy consists of fluid resuscitation and initiation of an insulin drip; however, there is longstanding controversy regarding the optimal insulin-starting dose for the management of DKA in the pediatric population.