The Role of Renal Regulatory Mechanisms in the Evolution and Treatment of Pediatric Diabetic Ketoacidosis

Olugbenga A. Akingbola, Dinesh Singh, Ihor V. Yosypiv, Edwin M. Frieberg, Mary A. Younger, Samir S. El-Dahr

Department of Pediatrics, Division of Pediatric Critical Care, Tulane University Medical Center, New Orleans, USA.
Department of Pediatrics, Division of Pediatric Endocrinology, Tulane University Medical Center, New Orleans, USA.
Department of Pediatrics, Division of Pediatric Nephrology, Tulane University Medical Center, New Orleans, USA.

DOI: 10.4236/ojemd.2013.31013                

Abstract

Diabetic ketoacidosis (DKA) is a life threatening complication of diabetes mellitus in pediatric patients with new onset insulin dependent diabetes. Despite advances in therapy mortality from DKA, especially in children less than two years, remains high. This review highlights the role of obligatory renal defense mechanisms in the evolution of DKA and its implication for therapy: to accomplish this goal the review starts with a cursory description of the pathogenesis and pathophysiology of metabolic derangements in DKA as a basis for understanding the renal compensatory mechanisms geared towards restoration of acid-base balance; then, the next section of the review describes how alterations in fluid and electrolyte balance at the onset of DKA and the extent of renal regulatory defense mechanisms geared towards its restoration can predispose to cerebral edema at the beginning of therapy. We conclude by suggesting that restoration of fluid and electrolyte balance should be based on the severity of metabolic acidosis as determined by the extent of renal impairment at the onset and during the course of DKA rather than strictly by protocols.

Keywords

Diabetic Ketoacidosis; Pediatrics; Hyperosmolar; Cerebral Edema; Hyperglycemia; Hyperkalemia

Conflicts of Interest

The authors declare no conflicts of interest.

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