P-362: Development of an evidence-based consensus guideline for the emergency and critical care management of diabetic ketoacidosis in children and adolescents
D ZamanfarAbstract
Introduction
Diabetic ketoacidosis (DKA) remains a serious acute complication of diabetes in children and adolescents and requires prompt, standardized management. Although several protocols have been updated recently, differences among recommendations may contribute to variation in practice. A harmonized framework may help support safe and consistent care.
Objectives
To develop an evidence-based consensus guideline for the emergency and critical care management of pediatric DKA through synthesis of contemporary international recommendations.
Methods
Six international guidance documents and clinical protocols published between 2018 and 2025 were reviewed. Recommendations on diagnosis, severity assessment, fluid management, insulin therapy, electrolyte replacement, monitoring, warning signs, and complications were extracted and compared. Areas of agreement and divergence were identified and integrated into a unified clinical algorithm, supported by practical appendices and bedside reference tools.
Results
The reviewed documents agreed on diagnosis, severity grading, initial stabilization, insulin after fluids, potassium monitoring, avoidance of routine bicarbonate, and early recognition of cerebral injury. Differences were mainly in calculating fluid bolus volumes, timing and dose of insulin, rate of rehydration, and thresholds for adding dextrose. These findings informed a pediatric-specific pathway using cautious isotonic resuscitation, delayed insulin until after initial fluids and safe potassium levels, gradual deficit replacement, and ongoing neurological monitoring.
Conclusions
This consensus guideline combines international recommendations into a practical framework for pediatric DKA management. It may reduce variation in care, support safer treatment decisions, and improve patient safety in children and adolescents with DKA.