How to Treat Ketoacidosis

Ketoacidosis is defined as a pH of less than 7.4 in the arterial blood as a result of excess ketones. It is usually the result of an insulin deficiency caused by diabetes. Ketoacidosis is a significant cause of death in children with diabetes, especially when it is first diagnosed. Prompt diagnosis and treatment are therefore essential in these cases.

Instructions

• 1

  Apply the ABCs (airway, breathing and circulation) of resuscitation as the first treatment for ketoacidosis. Children must be monitored especially closely and any change in status addressed promptly.

• 2

  Replace fluids using one half to full isotonic saline in mild to moderate cases of ketoacidosis. The current practice is to slowly correct the fluid deficit over one to two days. Severe cases should be treated initially with 10 to 20 ml/kg of 0.9 percent saline over 30 minutes.

• 3

  Administer insulin intravenously an hour after fluid replacement has begun to reduce the risk of cerebral edema. A continuous low-dose infusion is generally safer as it reduces the risk of sudden hypoglycemia and hypokalemia. The most common dosage of insulin is 0.1 U/kg/hr.

• 4

  Begin potassium replacement after initial fluid resuscitation if the plasma level is below 5 mEq/l. Potassium chloride is most commonly used.

• 5

  Conduct regular assessments of these important measurements. Recording charts specifically designed for diabetics greatly facilitate the care of these patients. Neurologic status should be reviewed at least hourly during the first 12 hours of treatment.