[Treatment of diabetic ketoacidosis in children and adolescents].

Despite low mortality rates, diabetic ketoacidosis in children and adolescents remains a potentially fatal condition. In this age group, cerebral edema, rapid decreases of serum potassium levels and severe hypoglycaemia seem to represent the most frequent complications of therapy which have to be avoided. This paper attempts to critically evaluate some greatly different treatment schedules previously published and presents our own experiences with a practicable therapeutic concept which has proved to be simple and safe and only slowly corrects the metabolic deviations. Insulin is administered by continuous intravenous infusion at a rate of 0.1 IU/kg bwt per hour following an initial bolus injection of 0.1 IU/kg. After reduction of blood glucose values to less than or equal to 250 mg/dl, the infusion rate can be reduced to half. For rehydration we use isotonic saline solution at a rate of 100-150 ml/kg body weight and per day, depending on age as far as basal fluid requirements are concerned, and the degree of dehydration, around one half during the first eight hours, the second half during the subsequent 16 hours. Potassium substitution begins after the onset of diuresis, supplying between 3 and 5 mmol/kg body weight during 24 hours. Bicarbonate substitution has proved to be hardly ever necessary and is only used in patients exhibiting the most severe clinical condition.(ABSTRACT TRUNCATED AT 250 WORDS)