1022 SECTION VII I Pediatric Critical Care Metabolic and Endocrine DKA and poor glycemic control In a larger study of home based psychotherapy for adolescents with poorly controlled dia betes, admissi[.]
1022 S E C T I O N V I I I Pediatric Critical Care: Metabolic and Endocrine DKA and poor glycemic control In a larger study of homebased psychotherapy for adolescents with poorly controlled diabetes, admissions for DKA were reduced by almost half over a 2-year period, resulting in a cost savings of $23,886 to $72,226 (the range reflecting hospital costs and third-payer costs, respectively).131 These examples emphasize the need for preventive rather than crisis-based approaches to the pediatric diabetes population Management of DKA with utilization of bOHB measurement has been shown to reduce overall care costs during hospitalization by reducing length of stay in the ICU, overall time in hospitalization, reduced laboratory measurements, and clinical assessments.132 Very young children with diabetes are the most likely to present in DKA and constitute the age group with the most rapid rise in incidence of diabetes These data suggest that there are important opportunities for prevention strategies in this age group Major efforts are needed to address healthcare disparities overall in children with diabetes, and prevention of DKA is no exception Key References Bureau M, Begin R, Berthiaume Y, Shapcott D, Khoury K, Gagnon N Cerebral hypoxia from bicarbonate infusion in diabetic acidosis J Pediatr 1980;96:968-973 Decourcey DD, Steil GM, Wypij D, Agus MS Increasing use of hypertonic saline over mannitol in the treatment of symptomatic cerebral edema in pediatric diabetic ketoacidosis: an 11-year retrospective analysis of mortality Pediatr Crit Care Med 2013;14:694-700 Edge J, Jakes R, Roy Y, et al The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children Diabetologia 2006;49:2002-2009 Glaser N, Barnett P, McCaslin I, et al Risk factors for cerebral edema in children with diabetic ketoacidosis N Engl J Med 2001;344:264-269 Grimberg A, Cerri R, Satin-Smith M, Cohen P The “two bag system” for variable intravenous dextrose and fluid administration: benefits in diabetic ketoacidosis management J Pediatr 1999;134:376-378 Gutierrez J, Bagatell R, Samson M, Theodorou A, Berg R Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis Crit Care Med 2003;31:80-83 Koves I, Neutze J, Donath S, et al The accuracy of clinical assessment of dehydration during diabetic ketoacidosis in childhood Diabetes Care 2004;27:2485-2487 Kuppermann N, Ghetti S, Schunk J, et al Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis N Engl J Med 2018;378: 2275-2287 Lawrence S, Cummings E, Gaboury I, Daneman D Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis J Pediatr 2005;146:688-692 Marcin J, Glaser N, Barnett P, et al Clinical and therapeutic factors associated with adverse outcomes in children with DKA-related cerebral edema J Pediatr 2003;141:793-797 Nallasamy K, Jayashree M, Singhi S, Bansal A Low-dose vs standarddose insulin in pediatric diabetic ketoacidosis: a randomized clinical trial JAMA Pediatr 2014;168:999-1005 Rewers A, Klingensmith G, Davis C, et al Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study Pediatrics 2008;121:e1258-e1266 Rosenbloom A Hyperglycemic crises and their complications in children J Pediatr Endocrinol Metab 2007;20:5-18 Wolfsdorf JI, Glaser N, Agus M, et al Diabetic ketoacidosis and hyperglycemic hyperosmolar state: a consensus statement from the International Society for Pediatric and Adolescent Diabetes Pediatr Diabetes 2018;19(suppl 27):155-177 The full reference list for this chapter is available at ExpertConsult.com e1 References Sheikh-Ali M, Karon BS, Basu A, et al Can serum beta-hydroxybutyrate be used to diagnose diabetic ketoacidosis? 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Pediatrics 2004;113:e47-e50 131 Ellis D, Naar-King S, Templin T, et al Multisystemic therapy for adolescents with poorly controlled type diabetes: reduced diabetic ketoacidosis admissions and related costs over 24 months Diabetes Care 2008;31:1746-1747 132 Vanelli M, Chiari G, Capuano C, et al The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment Diabetes Nutr Metab 2003;16(5-6):312-316 e4 Abstract: Diabetic ketoacidosis (DKA) results either from absolute insulin deficiency or from relative insulin deficiency in the setting of high levels of counterregulatory hormones stimulated by infection or other illness DKA is characterized by hyperglycemia, ketosis, and acidosis Treatment of pediatric DKA involves intravenous insulin administration, intravenous fluid administration to correct dehydration, and replacement of electrolyte deficits Cerebral injury is the most frequent serious complication of DKA in children and the most frequent cause of morbidity and mortality resulting from DKA Key words: Diabetic ketoacidosis, DKA, hyperglycemia, ketosis, acidosis ... bicarbonate in management of diabetic ketoacidosis Diabetes 1973;23:405-411 68 Bureau M, Bégin R, Berthiaume Y, Shapcott D, Khoury K, Gagnon N Cerebral hypoxia from bicarbonate infusion in diabetic