Recent advances in management of diabetic ketoacidosis.

Diabetic ketoacidosis is the most common endocrine emergency in children and frequently it is the initial presentation of insulin dependent diabetes mellitus. Despite sophisticated technology and our improved understanding of the pathophysiology of this disease, the mortality from intracranial complications remains constant over the past two decades. Several management protocols are used all over the world but the recent trend in opinion seems to be one of the slower rates of initial hydration aimed at matching the osmolarity of the infusion solutions with the patient's serum osmolarity. It remains to be seen if widespread use of this rehydration strategy will improve morbidity in the future. A protocol for managing diabetic ketoacidosis is suggested.