Outpatient management of diabetic ketoacidosis
W. A. Bonadio, M. F. Gutzeit, J. D. Losek and D. S. Smith
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital, Milwaukee 53233.
An analysis of 63 pediatric diabetic patient visits to an emergency
department for diabetic ketoacidosis was performed. Of 27 patients with a
serum pH less than 7.20 or bicarbonate concentration less than 10 mmol/L
(10 mEq/L) at admission, 25 (92%) had persistence of metabolic acidosis
after three hours of outpatient therapy and were hospitalized. Of 36
patients with a serum pH greater than or equal to 7.20 or a bicarbonate
concentration greater than or equal to 10 mmol/L (10 mEq/L) at admission,
34 (94%) had resolution of metabolic acidosis within three hours of
initiating outpatient therapy and were discharged from the emergency
department. The relapse rate in each group was similar. The initial serum
glucose concentration accurately predicted duration of therapy necessary to
resolve metabolic acidosis in the majority of patients discharged. Certain
diabetic children can be treated for diabetic ketoacidosis with therapy
administered in an outpatient setting. Most patients with an initial serum
pH of 7.20 or higher or a bicarbonate concentration of 10 mmol/L (10 mEq/L)
or higher will experience resolution of acidosis and tolerate feeding
within three hours of initiating treatment.
