Clinical features and diagnosis of diabetic ketoacidosis in children INTRODUCTION — Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus. DKA can less commonly occur in children with type 2 diabetes mellitus [1,2]. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) In recent years, the incidence and prevalence of type 2 diabetes mellitus have increased across all ethnic groups. This has been coupled with an increasing awareness that children with type 2 diabetes mellitus can present with ketosis or DKA, particularly in obese African American adolescents [1-6]. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'DKA in type 2 diabetes'.) The clinical features and diagnosis of DKA in children will be reviewed here. This discussion is primarily based upon the large collective experience of children with type 1 diabetes mellitus. There is limited experience in the assessment and diagnosis of DKA in children with type 2 diabetes mellitus, although the same principles should apply. The management of diabetes in children, treatment of DKA in children and the epidemiology and pathogenesis of DKA are discussed separately. (See "Management of type 1 diabetes mellitus in children and adolescents" and "Treatment and complications of diabetic ketoacidosis in children" and "Epidemiology and pathogenesis of diabetic ketoacidosis and hyperosmolar hyperglycemic state".) DEFINITION — Consensus statements from the European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society (ESPE/LWPES) in 2004, the American Diabetes Association (ADA) in 2006, and the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2007 defined the following biochemical criteria for the diagnosis of DKA [7-10]: •
Hyperglycemia, blood glucose of >200 mg/dL (11 mmol/L)
Metabolic acidosis, defined as a venous pH 15 mmol/L, absent to mild...
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