Diabetic Ketoacidosis Complications and Management in Pediatrics: A Narrative Review
Authors: Abu Aser Madleen , Al-Tourk Hameedo GH. , El-Jedi Ashraf YA. , Aldirdasawi Tareq K. , Esleem Mymona S. 
Published: September 2023

Diabetic ketoacidosis (DKA) is an endocrine emergency that affects both newly diagnosed and long-term type I diabetic patients as a result of decreasing insulin levels in the blood, insulin resistance, and elevated levels of counter-regulatory hormones. A common and deadly acute consequence in kids with diabetes mellitus is diabetic ketoacidosis. When type I diabetes is newly diagnosed, it can be accompanied by diabetic ketoacidosis. It can also happen when type I diabetes is already present, such as when the demands of an acute illness are more than usual or when insulin administration is decreased as a result of missed doses or insulin pump failure. Furthermore, there are more reports of diabetic ketoacidosis events in kids with type II diabetes mellitus. Although the diagnosis is typically simple in a patient with established diabetes and the anticipated symptoms, a sizable portion of patients with new-onset diabetes initially present with diabetic ketoacidosis. Children with diabetic ketoacidosis are typically treated in an emergency room for the first time. The differential diagnosis of pediatric metabolic acidosis must take diabetic ketoacidosis into account as a significant factor. The pathogenesis, therapy, and probable consequences of this illness will be explained to emergency medicine doctors in this review) Heddy, 2021). The management of pediatric patients draws attention to the uncommon but fatal occurrence of cerebral edema and the excessive use of fluid boluses that may or may not be related to it. Guidelines for managing DKA in adults should not be applied to children and adolescents.
The diagnosis of DKA is based on clinical suspicion and subsequent laboratory confirmation:

Hyperglycemia (sugar level greater than 11 mmol/L): diabetes warning sign.
pH 7.3 and 15 mmol/L of bicarbonate indicate metabolic acidosis.
Ketosis, which may include ketonuria or ketonaemia.

The severity of DKA depends on the acidity level:

Mild: pH 7.3 and/or 15 mmol/L of bicarbonate; Moderate: pH 7.2 and/or 10 mmol/L of bicarbonate.
Ketoacidosis associated with diabetes (DKA) Extremely severe: pH 7.1 and/or 5 mmol/L of bicarbonate.
DKA can have various deadly consequences.
Acute hypoglycemia (during treatment or as a result of utilizing an excessive amount of insulin pump) Cerebral edema, Acute hypokalemia, Acute hypoglycemia, Spontaneous pneumonia.

A, B, and C for initial CPR
If at all possible, weigh the patient and then use that weight in all calculations. Use an estimated weight from a centile chart or a weight from a recent medical visit as an alternative.

Make sure the airway is open. Insert an airway if a child is unconscious (Glasgow Coma Scale Score of 8). In the event that the patient is vomiting or has a reduced level of awareness, insert NGT, aspirate, and place on free drainage.
B. An oxygen-only face mask.
Draw blood when an IV cannula is in place.

Only if the patient is shocked (poor peripheral pulses, poor capillary filling with tachycardia, and/or hypotension) should you provide a bolus of 10 ml/kg 0.9% sodium chloride. Repeat the fluid bolus only after contacting a doctor or pediatric endocrinologist if shock symptoms continue.