Diabetes ketoacidosis approach in childhood and adolescence

Abstract

Introduction: diabetic ketoacidosis is the most common endocrine-metabolic urgency in childhood and adolescence and the main cause of hospitalization and death of diabetic patients in this age group. Objective: to review the pathophysiology of diabetic ketoa­cidosis and propose a diagnostic and therapeutic approach for children and adolescents, in addition to discuss prevention measures. Data source: non-systematic review of the national and international medical literature, original papers, Brazilian therapeutic proto­cols and consensus on the theme available until 2017, in the Portuguese and English langua­ges, from PubMed search. Data synthesis: diabetic ketoacidosis may be the first clinical manifestation in newly diagnosed cases of type 1 diabetes mellitus or occurs in established type 1 diabetes, usually due to poor glycemic control or insulin omission. The pillars of the treatment of diabetic ketoacidosis are the replacement of fluids and insulin, aiming at the correction of acidosis and hydroelectrolytic disorders. Diabetic ketoacidosis related mor­tality ranges from 0.15 to 0.3%, with cerebral edema being the main cause. Conclusion: the early diagnosis of type 1 diabetes mellitus and the adequate recognition and manage­ment of diabetic ketoacidosis are fundamental for reducing the morbidity and mortality of diabetes in childhood.