Repletion with potassium phosphate often thought unnecessary, although some recommend giving potassium phosphate to replete both of these electrolytes. Admit to ICU or floors depending on clinical status. Typically, patients with DKA are admitted. The leading cause of DKA mortality in children is cerebral edema, which occurs 4-12 hours into treatment. It is often associated with ongoing hyponatremia.
Cerebral edema is correlated with the administration of bicarbonate.
Concerns about the role of overaggressive or overly hypotonic fluid resuscitation as a cause of the edema have been raised in the past. Cerebral edema is a complication that affects primarily children. Hypokalemia is a complication that is precipitated by failing to rapidly address the total body potassium deficit brought out by rehydration and insulin treatment, which not only reduce acidosis but directly facilitate potassium reentry into the cell. Hypoglycemia may result from inadequate monitoring of glucose levels during insulin therapy. Acute pulmonary edema potentially is related to aggressive or excessive fluid therapy.