Article
Pediatrics
Nicole S. Glaser, Michael J. Stoner, Aris Garro, Scott Baird, Sage R. Myers, Arleta Rewers, Kathleen M. Brown, Jennifer L. Trainor, Kimberly S. Quayle, Julie K. McManemy, Andrew D. DePiero, Lise E. Nigrovic, Leah Tzimenatos, Jeff E. Schunk, Cody S. Olsen, T. Charles Casper, Simona Ghetti, Nathan Kuppermann
Summary: Research findings suggest that changes in glucose-corrected sodium concentrations during diabetic ketoacidosis treatment are influenced by various factors, including sodium and chloride concentrations at presentation, pre-existing diabetes, and the sodium content of intravenous fluids. However, declines in glucose-corrected sodium concentrations are not associated with mental status changes during treatment.
Article
Biochemistry & Molecular Biology
Alexandra-Cristina Scutca, Delia-Maria Nicoara, Niculina Mang, Iulius Juganaru, Giorgiana-Flavia Brad, Otilia Marginean, Galina F. Sud'ina
Summary: This study investigated the relationship between neutrophil-to-lymphocyte ratio (NLR) levels and the presence of cerebral edema in children with severe diabetic ketoacidosis (DKA). The results showed that lower blood pH and elevated NLR and blood urea were associated with cerebral edema. After adjusting for confounding factors, NLR remained positively associated with cerebral edema. Therefore, NLR may be an additional tool to identify high-risk patients with severe cerebral edema.
Article
Multidisciplinary Sciences
William H. Hoffman, Stephen A. Whelan, Norman Lee
Summary: Diabetic ketoacidosis (DKA) is a serious complication of Type 1 diabetes (T1D) caused by insulin deficiency and insulin resistance. The metabolic and immunologic dysregulation in DKA leads to oxidative stress, inflammation, and the development of brain edema (BE). Changes in the tryptophan (TRP)/kynurenine pathway (KP) metabolites may play a role in the pathogenesis of DKA/BE.
Article
Endocrinology & Metabolism
Arleta Rewers, Nathan Kuppermann, Michael J. Stoner, Aris Garro, Jonathan E. Bennett, Kimberly S. Quayle, Jeffrey E. Schunk, Sage R. Myers, Julie K. McManemy, Lise E. Nigrovic, Jennifer L. Trainor, Leah Tzimenatos, Maria Y. Kwok, Kathleen M. Brown, Cody S. Olsen, T. Charles Casper, Simona Ghetti, Nicole S. Glaser
Summary: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco(2) than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.
Article
Medicine, General & Internal
Hugo Segerer, Michael Wurm, Julia M. Grimsmann, Beate Karges, Andreas Neu, Marina Sindichakis, Katharina Warncke, Axel Dost, Reinhard W. Holl
Summary: The study found that the incidence of DKA at the time of T1D diagnosis in children and adolescents did not decrease between 2000 and 2019. Patients with MiH, children under 6, and girls were at a higher risk of DKA.
DEUTSCHES ARZTEBLATT INTERNATIONAL
(2021)
Review
Pediatrics
William Bonadio
Summary: Diabetic ketoacidosis (DKA) is a common and serious acute complication in children with diabetes mellitus. It can be associated with the onset and treatment of diabetes, but can also occur in new cases. Understanding the pathophysiology, treatment caveats, and potential complications of DKA is important for clinicians.
CLINICAL PEDIATRICS
(2022)
Article
Endocrinology & Metabolism
Lise E. Nigrovic, Nathan Kuppermann, Simona Ghetti, Jeff E. Schunk, Michael J. Stoner, Arleta Rewers, Julie K. Mcmanemy, Kimberly S. Quayle, Jennifer L. Trainor, Leah Tzimenatos, Jonathan E. Bennett, Maria Y. Kwok, Sage R. Myers, Kathleen M. Brown, T. Charles Casper, Cody S. Olsen, Nicole S. Glaser
Summary: This study investigated the relationship between demographic factors and the presentation of diabetic ketoacidosis (DKA) in children. It found that children from low socioeconomic status were more likely to have severe DKA, and young children had a higher risk of cerebral injury.
PEDIATRIC DIABETES
(2023)
Article
Medicine, General & Internal
Kelly R. Bergmann, Amanda Nickel, Matt Hall, Gretchen Cutler, M. Jennifer Abuzzahab, Brianna Bretscher, Shea Lammers, Dave Watson, Gabrielle Z. Hester
Summary: The study aimed to explore the association between the Child Opportunity Index and health outcomes in children with type 1 diabetes of different races and ethnicities. The results suggest that there are disparities in health outcomes among Black children compared to other racial and ethnic groups. These findings highlight the importance of considering racial disparities and community factors in preventing readmissions for diabetic ketoacidosis.
Editorial Material
Pediatrics
Karen E. Gripp, Evelyne D. Trottier, Sidd Thakore, Jonathan Sniderman, Sarah Lawrence
Summary: Treatment of paediatric diabetic ketoacidosis involves careful fluid and electrolyte management to minimize the risk of complications, such as cerebral injury. Despite the use of fluid-limiting protocols, cerebral edema incidence remains unchanged. New evidence suggests that early isotonic fluid therapy is beneficial and protocols are being adjusted to focus on initial and ongoing fluids and electrolyte monitoring and replacement. Initial isotonic fluid resuscitation is now recommended for all patients within the first 20 to 30 minutes, followed by volume repletion, insulin infusion, electrolyte supplementation, and monitoring and management of potential cerebral injury.
PAEDIATRICS & CHILD HEALTH
(2023)
Article
Pediatrics
Nicole S. Glaser, Kimberly S. Quayle, Julie K. McManemy, Lise E. Nigrovic, Leah Tzimenatos, Michael J. Stoner, Jonathan E. Bennett, Jennifer L. Trainor, Arleta Rewers, Jeff E. Schunk, Sage R. Myers, Maria Y. Kwok, Kathleen M. Brown, Simona Ghetti, T. Charles Casper, Cody S. Olsen, Nathan Kuppermann
Summary: This study found that lower pH and higher BUN levels at presentation are associated with cerebral injury.
JOURNAL OF PEDIATRICS
(2022)
Review
Pediatrics
Namita Ravikumar, Arun Bansal
Summary: Management of severe DKA in children focuses on restoring physiological processes and maintaining fluid balance, with individualized therapy being crucial. New evidence drives guideline revisions, towards more conservative treatment approaches with emphasis on continuous and advanced monitoring.
TRANSLATIONAL PEDIATRICS
(2021)
Article
Spectroscopy
Di Wu, Yi-Wen Luo, Ji Zhang, Bin Luo, Kai Zhang, Kai Yu, Rui-Na Liu, Han-Cheng Lin, Xin Wei, Zhen-Yuan Wang, Ping Huang
Summary: This study utilized FTIR microspectroscopy coupled with chemometrics to characterize pulmonary edema fluid from different causes of death and established models for diagnosing diabetic ketoacidosis. The results showed that variations in proteins can effectively differentiate deaths caused by DKA.
SPECTROCHIMICA ACTA PART A-MOLECULAR AND BIOMOLECULAR SPECTROSCOPY
(2021)
Article
Anesthesiology
Katherine H. Loh, Jennifer C. Kelley, Susan S. Eagle
Summary: Diabetic ketoacidosis is a major concern for children with type 1 diabetes, and its management requires careful monitoring and treatment of dehydration and metabolic imbalances. This article presents a case of diabetic ketoacidosis diagnosed during spinal fusion surgery in an adolescent patient and discusses the management of this unexpected intraoperative emergency.
PEDIATRIC ANESTHESIA
(2023)
Article
Endocrinology & Metabolism
Zoyah Thawer, Keith Gregoire, Helen Coo, David Seleman Saleh
Summary: The study aimed to analyze the treatment of DKA pediatric patients and track complications; results showed a significant proportion of patients deviated from guidelines, with those presenting to community hospitals more likely to be exposed to practices increasing risk of cerebral edema.
CANADIAN JOURNAL OF DIABETES
(2021)
Article
Pediatrics
Ramachandran Rameshkumar, Ponnarmeni Satheesh, Puneet Jain, Jagadeesh Anbazhagan, Shilpa Abraham, Seenivasan Subramani, Narayanan Parameswaran, Subramanian Mahadevan
Summary: The study compared the efficacy of insulin infusion at 0.05 Unit/kg/hour versus 0.1 Unit/kg/hour in the management of pediatric diabetic ketoacidosis (DKA), finding similar resolution times for ketoacidosis but a lower rate of complications in the low-dose group. Therefore, low-dose insulin infusion may be a safer approach in the management of pediatric DKA.