Fluid and electrolyte therapy in childhood diabetic ketoacidosis management: A rationale for new national guideline

Juliana Chizo Agwu, Sze M Ng

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Abstract

Fluid and electrolyte therapy in childhood diabetic ketoacidosis (DKA) management has been controversial. Previous National Institute for Health and Care Excellence (NICE) 2015 guidance advocated a restricted fluid regimen while more recent guidelines have advocated a more liberal approach to fluid replacement in DKA. At the core of the debate is the need to avoid developing cerebral oedema as a complication. Although subtle asymptomatic cerebral oedema is common in children presenting in DKA, clinically apparent cerebral oedema is rare and has been reported in approximately 0.5%-1% of DKA cases in children. Recent research evidence has shown that there was no clear evidence of a difference in rates of clinically apparent cerebral injury in children in DKA managed with a range of fluid volumes and rates of rehydration. In view of this, NICE has updated its guideline. In this paper, we review literature evidence underpinning the current understanding of the pathophysiology of cerebral oedema in children and discuss the rationale for the new NICE guidance.

Original languageEnglish
Article numbere14595
JournalDiabetic Medicine
Volume38
Issue number8
Early online date8 May 2021
DOIs
Publication statusE-pub ahead of print - 8 May 2021

Bibliographical note

© 2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Keywords

  • children and adolescents
  • in-patient diabetes
  • other complications

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