Diabetic ketoacidosis in the pediatric patient.

Diabetic ketoacidosis is the major source of morbidity and mortality in patients with Type I diabetes mellitus. One population-based study noted that approximately 25% of newly diagnosed patients present with diabetic ketoacidosis. Most of those hospitalized with diabetes ketoacidosis, however, are those with poor control of their pre-existing diabetes. Cerebral edema has been found to be present in only 1% of children with diabetic ketoacidosis, but accounts for 20% of all diabetes-related deaths. Although the mortality rate has fallen dramatically over the course of the last century, the underlying mechanisms involved with the development of cerebral edema are still not clear. Several studies have shown specific risk factors to be associated with cerebral edema, but as of yet no reduction in the recent incidence of cerebral edema has been demonstrated. A discussion of these risk factors and a suggested protocol for treating diabetic ketoacidosis are included in this review.