Insulin therapy during diabetic ketoacidosis in children.

Diabetic ketoacidosis is still today a medical emergency in pediatrics. Despite the latest great sensibilization of the population and the doctors, the risk of DKA has not yet been completely eliminated and this pathology is still occurring in 25 to 40% of diabetes onset cases, in already diagnosed patients with poor compliance, or in patients undergoing acute medical or surgical events. In affected patients, missed recognition can influence morbility and mortality rates. Despite the improvement in DKA management and therapy, a lot of controversies have been encountered through a careful review of the most recent literature in the sector (guidelines in Pediatrics). Particularly as far as DKA pathophysiology and its complications (cerebral oedema) are concerned. In terms of insulin therapy the latest progress has underlined the advantages and disadvantages of the therapeutical choices that have modified in time. A wide consent exists on the need to use small doses of regular insulin for continuous intravenous administration as therapy of choice for pediatric DKA (0.1-0.05 U/Kg/h). The success of the treatment is nevertheless tightly connected to a correct management of rehydratation, of metabolic acidosis and of electrolyte deficit replacement more than on insulin therapy, aimed at avoiding the most dangerous complication of DKA: cerebral oedema.