Management

Management and treatment of DKA rests on four pillars:

1. Fluid and electrolyte therapy.

2. Intravenous insulin therapy.

3. Treatment of co-morbidities.

4. Careful monitoring of the clinical course.

It is particularly important that treatment is initiated without delay and that the patient is monitored frequently and carefully, preferably in a highly specialised unit. Severe cases should be treated and monitored in intensive care unit, where possible. Useful algorithms for treatment are available from many sources including the American Diabetes Association. In general the overall goal is a controlled, gradual correction of metabolic abnormalities and fluid and electrolyte deficiencies in the course of around 24 h.

Treatment of DKA in children and young adolescents follows slightly different guidelines than those presented here [19]. It is recommended that insulin is given continuously intravenously (0.1 IU/kg BW/h) after initiation of fluid and electrolyte therapy in order to minimise the risk of cerebral oedema. Otherwise children are in general treated with weight-reduced doses as indicated later.

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