Concepts of fluid therapy in diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma

Pediatric Clinics of North America
E N Ellis

Abstract

Despite many advances in the overall treatment of type I diabetes mellitus during the last few years, no major advance has been made in decreasing the mortality rate of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic coma. A major concern in both of these disease states is the development of cerebral edema during treatment. The guiding principles of therapy in both disease states are rehydration, electrolyte replacement, insulin therapy, and treatment of any underlying illnesses. If the patient is hypotensive, therapy begins with colloid or normal saline administration to support blood pressure. Fluid and electrolyte deficits should be calculated and replaced during 48 hours. Low-dose insulin therapy is employed for treatment of hyperglycemia. Neurologic function should be carefully monitored and mannitol administered if a change in neurologic function occurs.

Citations

Feb 24, 2001·Diabetes Care·A E KitabchiB M Wall
Dec 2, 2000·International Anesthesiology Clinics·G W GrahamD B Coursin
Apr 21, 2001·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·J Y Ting
Jan 31, 2006·Indian Journal of Pediatrics·R Venkatraman, Sunit C Singhi
Aug 29, 2012·Pediatric Diabetes·Dayanand BagdureMarion R Sills
May 14, 2014·Medizinische Klinik, Intensivmedizin und Notfallmedizin·W A Scherbaum, C R Scherbaum
Nov 3, 2010·The Journal of Pediatrics·Phil ZeitlerUNKNOWN Drugs and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society

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