Chapter 11: Diabetic ketoacidosis and hyperglycemic hypersmolar state
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12/14/2017 at 9:47:12 AM GMT
Posts: 39
Chapter 11: Diabetic ketoacidosis and hyperglycemic hypersmolar state

Dear ISPAD member/friend,

The 2014 ISPAD Clinical Practice Consensus Guidelines were much appreciated. We are happy to announce that preparations for the 2018 Guidelines are now well underway and that a new draft chapter is now ready for your comments and input. We look forward to hearing your thoughts and ideas on the Diabetic ketoacidosis and hyperglycemic hypersmolar state chapter here below!

Kind regards,

David Maahs
ISPAD Secretary-General


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Last edited Tuesday, February 20, 2018
12/19/2017 at 1:08:23 AM GMT
Posts: 6
Congratulations on this important body of work and many thanks for including the updated PECARN data. This is a significant addition to the field.

Under the section that deals with the complication of cognitive impairment (page 43), may I suggest adding in the more recent work by Shehata et al J Child Neurol 2010; 25:469-74 showing that DKA impacted on many more cognitive domains other than just memory, and our prospective studies (Nadebaum et al Pediatr Diabetes 2012; 13:632-7, and Cameron et al Diabetes Care 2014; 37:1554-62) showing the importance of altered mental state and subclinical grey/white matter volume changes at diagnosis as predictors of subsequent cognitive function in the medium term.

Best,

Fergus Cameron


1/6/2018 at 3:16:06 PM GMT
Posts: 9
Fergus,

Thank you for your comments. I will amend the article to include effects of DKA on other cognitive domains and grey/white matter changes. JW


1/22/2018 at 7:06:03 PM GMT
Posts: 1

Regarding treatment of DKA on replacement/resuscitation fluids, our guidelines report that a volume of 10-20ml/kg over 1-2h is typically administered and it may be repeated.

During last few years I have been requested to analyze, for a medico-legal assessment, a couple of cases of children with DKA complicated with cerebral edema esitated with permanent neurological damage (we recently reported on Scient Rep 2016). Both cases started with a fluid replacement over 10ml/kg/h and the total fluid replacement during first 24 h was definetively high.

I am wondering if it could be useful to suggest to start the treament of DKA with a replacement volume of fluid between 5 to 10 ml/kg per hour during the first 2 hours and to consider a volume of 10-20 ml/kg per hour with hypotension and/or oliguria only.


Best,

Valentino Cherubini



Last edited Tuesday, January 23, 2018
1/25/2018 at 10:54:11 AM GMT
Posts: 39
The forum discussion on Chapter 11: Diabetic ketoacidosis and hyperglycemic hypersmolar state is now closed.

While ISPAD does very much appreciate your feedback, kindly note that any comments posted here after 25/01/2018 will only be taken into account for the 2022 Guidelines!

Thank you very much for your understanding.


Last edited Thursday, January 25, 2018

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