{
  "schemaVersion": 2,
  "eyebrow": "Pediatric endocrinology",
  "title": "Pediatric Diabetic Ketoacidosis",
  "summary": "Pediatric diabetic ketoacidosis requires rapid confirmation of hyperglycemia, ketonemia, and acidosis; protocolized isotonic fluid resuscitation, potassium replacement, and delayed low-dose intravenous insulin; and intensive neurologic surveillance for cerebral edema while treating the precipitant and preventing recurrence.[21]",
  "seoDescription": "Point-of-care management of pediatric diabetic ketoacidosis, including diagnostic criteria, fluid and insulin therapy, potassium replacement, monitoring, and cerebral edema.",
  "clinicalQuestion": "How should physicians diagnose, treat, monitor, and prevent complications of diabetic ketoacidosis in children and adolescents?",
  "specialty": "Pediatric endocrinology and emergency medicine",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "pediatric diabetic ketoacidosis",
    "DKA",
    "cerebral edema",
    "intravenous insulin",
    "fluid resuscitation",
    "beta-hydroxybutyrate"
  ],
  "keyTakeaways": [
    "Diagnose DKA by glucose >200 mg/dL, venous/capillary pH <7.3 or bicarbonate <15 mmol/L, and β-hydroxybutyrate >3 mmol/L or urine ketones at least 2+.[21]",
    "Begin 0.9% sodium chloride and potassium replacement before insulin; start continuous IV soluble insulin 1-2 hours after fluids at 0.05-0.1 units/kg/hour without an IV insulin bolus.[21]",
    "A declining mental status, headache, irritability, unexpected bradycardia, or rising blood pressure should prompt immediate treatment for cerebral edema; do not wait for imaging.[21]",
    "Continue insulin to clear ketosis even after glucose falls; add dextrose when plasma glucose is <252 mg/dL and increase dextrose if glucose is <108 mg/dL with persistent ketosis.[21]",
    "Before discharge, identify insulin omission, access barriers, intercurrent illness, and psychosocial contributors; reinforce written sick-day rules, blood ketone testing, and uninterrupted insulin access.[11][21]"
  ],
  "sections": [
    {
      "id": "diagnosis-and-triage",
      "eyebrow": "First decisions",
      "heading": "Confirm DKA and identify patients needing higher-acuity care",
      "intro": "Obtain treatment-critical studies without delaying resuscitation.",
      "paragraphs": [
        "In a child or adolescent with diabetes symptoms, vomiting, abdominal pain, hyperventilation, dehydration, or altered consciousness, measure point-of-care glucose and blood β-hydroxybutyrate promptly. DKA requires hyperglycemia with plasma glucose >200 mg/dL, acidosis defined by pH <7.3 or bicarbonate <15 mmol/L, and β-hydroxybutyrate >3 mmol/L or urine ketones at least 2+.[21] DKA can occur with normal glucose in patients already taking insulin; symptoms plus elevated ketones warrant urgent hospital assessment regardless of glucose.[21]",
        "At diagnosis obtain glucose, blood ketones, pH and pCO2, bicarbonate, sodium, potassium, urea, creatinine, and body weight; document mental status, perfusion, vital signs, respiratory pattern, emesis, and clinical dehydration.[21] Assess for infection or another precipitant when fever or hypothermia, hypotension, refractory acidosis, or lactic acidosis is present.[21]"
      ],
      "bullets": [
        "Classify severity as mild with pH <7.3 or bicarbonate <15 mmol/L, moderate with pH <7.2 or bicarbonate <10 mmol/L, and severe with pH <7.1 or bicarbonate <5 mmol/L.[21]",
        "Use one-to-one nursing in a high-dependency or pediatric ward setting for children <2 years or severe DKA; involve pediatric critical care for airway compromise, shock, or other critical illness.[21]",
        "Measure capillary glucose in children without known diabetes who have thirst, polyuria, weight loss, or fatigue plus nausea, vomiting, abdominal pain, hyperventilation, dehydration, or reduced consciousness.[21]"
      ],
      "subsections": [],
      "table": {
        "caption": "Diagnostic and severity criteria for pediatric DKA.[21]",
        "columns": [
          "Domain",
          "Criterion",
          "Immediate implication"
        ],
        "rows": [
          [
            "Hyperglycemia",
            "Plasma glucose >200 mg/dL",
            "Assess ketones and acid-base status when symptoms suggest DKA.[21]"
          ],
          [
            "Ketosis",
            "β-hydroxybutyrate >3 mmol/L or urine ketones ≥2+",
            "Treat as DKA when acidosis is also present.[21]"
          ],
          [
            "Acidosis",
            "pH <7.3 or bicarbonate <15 mmol/L",
            "Initiate protocolized DKA therapy and monitoring.[21]"
          ],
          [
            "Severe DKA",
            "pH <7.1 or bicarbonate <5 mmol/L",
            "Escalate monitoring and obtain frequent senior review.[21]"
          ]
        ]
      }
    },
    {
      "id": "initial-treatment",
      "eyebrow": "First hours",
      "heading": "Use isotonic fluids, potassium, and continuous insulin in the correct sequence",
      "intro": "Avoid insulin boluses and avoid stopping insulin solely because glucose has normalized.",
      "paragraphs": [
        "For clinically dehydrated children without shock, give 0.9% sodium chloride 10 mL/kg intravenously over 30 minutes. Reassess perfusion before considering a second 10 mL/kg bolus and discuss additional boluses with the senior pediatric clinician. For hypotensive shock with a weak, thready pulse, give 10 mL/kg 0.9% sodium chloride promptly.[21]",
        "Calculate the first 48-hour fluid plan using estimated deficit plus maintenance. Assume 5% dehydration in mild-to-moderate DKA with pH ≥7.1 and 10% dehydration in severe DKA with pH <7.1; replace the deficit evenly over 48 hours. Use Holliday-Segar maintenance, capped at 75 kg, and subtract non-shock initial boluses from the estimated deficit.[21]",
        "Begin a soluble insulin infusion 1-2 hours after fluid therapy begins at 0.05-0.1 units/kg/hour; do not give an IV insulin bolus. Disconnect an insulin pump when IV insulin begins. If hypokalemia is present initially, provide potassium before starting insulin; if previously using basal insulin, continuing subcutaneous basal insulin can be considered in consultation with a diabetes specialist.[21]"
      ],
      "bullets": [
        "Use 0.9% sodium chloride without dextrose until plasma glucose is <252 mg/dL, then change to 0.9% sodium chloride with 5% dextrose and potassium chloride.[21]",
        "When glucose is <108 mg/dL, increase the glucose concentration in IV fluid; if ketosis persists, continue insulin at least 0.05 units/kg/hour.[21]",
        "Do not administer IV sodium bicarbonate unless life-threatening hyperkalemia or severe acidosis has impaired cardiac contractility and pediatric critical care has been consulted.[21]",
        "Do not replace urinary losses with additional IV fluid during DKA therapy.[21]"
      ],
      "subsections": [
        {
          "heading": "Potassium and sodium management",
          "paragraphs": [
            "Add potassium chloride 40 mmol/L to maintenance and rehydration fluids, excluding initial boluses, unless the patient is anuric or serum potassium is above the normal range. In patients initially hyperkalemic, add potassium once potassium is <5.5 mmol/L or urine output is documented. Insulin commonly unmasks total-body potassium depletion; do not delay replacement once it is safe.[21]",
            "Monitor sodium throughout therapy and calculate corrected sodium initially. Sodium should rise as glucose declines. A falling sodium concentration, or a rapid ongoing rise from free-water loss, may signal cerebral edema and requires immediate reassessment.[21]"
          ],
          "bullets": [
            "If potassium falls below 3 mmol/L, consider temporarily suspending insulin and urgently discuss management with pediatric critical care; potassium concentrations >40 mmol/L require central venous access.[21]"
          ]
        }
      ],
      "table": {
        "caption": "Initial treatment sequence for pediatric DKA.[21]",
        "columns": [
          "Step",
          "Action",
          "Operational detail"
        ],
        "rows": [
          [
            "1. Stabilize",
            "Assess airway, perfusion, neurologic status, and obtain diagnostic studies.",
            "Use pediatric high-acuity care for severe DKA, age <2 years, shock, or impaired airway protection.[21]"
          ],
          [
            "2. Restore volume",
            "Give 0.9% sodium chloride.",
            "10 mL/kg over 30 minutes if dehydrated without shock; prompt 10 mL/kg for hypotensive shock.[21]"
          ],
          [
            "3. Replace potassium",
            "Add potassium to ongoing fluids when appropriate.",
            "Usually 40 mmol/L; replace before insulin if initial hypokalemia is present.[21]"
          ],
          [
            "4. Start insulin",
            "Begin continuous IV soluble insulin after fluids.",
            "Start 1-2 hours after fluids at 0.05-0.1 units/kg/hour; no IV bolus.[21]"
          ],
          [
            "5. Add dextrose",
            "Prevent hypoglycemia while continuing ketone clearance.",
            "Add 5% dextrose when glucose is <252 mg/dL; increase dextrose if glucose is <108 mg/dL with persistent ketosis.[21]"
          ]
        ]
      }
    },
    {
      "id": "monitoring-and-complications",
      "eyebrow": "Safety surveillance",
      "heading": "Monitor neurologic status, electrolytes, glucose, and ketone clearance",
      "intro": "Cerebral edema is a clinical emergency, not an imaging diagnosis.",
      "paragraphs": [
        "Record capillary glucose, vital signs, fluid input/output, and modified Glasgow Coma Scale at least hourly. In children <2 years and those with severe DKA, assess consciousness and heart rate every 30 minutes. Use continuous ECG monitoring during IV therapy to identify hypokalemia-associated abnormalities.[21] Obtain laboratory glucose, pH/pCO2, sodium, potassium, urea, and β-hydroxybutyrate at 2 hours after treatment begins and at least every 4 hours thereafter.[21]",
        "A physician should perform direct reassessment at diagnosis and at least every 4 hours, more frequently for severe DKA, age <2 years, or clinical concern. At each review, reassess neurologic status, vital signs, laboratory data, ECG, and cumulative fluid balance.[21]",
        "If β-hydroxybutyrate is not declining by 6-8 hours, consider increasing insulin to 0.1 units/kg/hour or higher. Do not transition from IV to subcutaneous insulin until ketosis is resolving, the patient is alert, and oral fluids are tolerated without nausea or vomiting.[21]"
      ],
      "bullets": [
        "Early warning features of cerebral edema are headache, agitation or irritability, unexpected bradycardia, and increased blood pressure.[21]",
        "Treat immediately for cerebral edema with deterioration in consciousness, abnormal breathing or respiratory pauses, oculomotor palsy, or pupillary inequality/dilation.[21]",
        "Use either mannitol 20% 0.5-1 g/kg IV over 10-15 minutes or hypertonic sodium chloride 2.7% or 3%, 2.5-5 mL/kg IV over 10-15 minutes; seek immediate specialist guidance after treatment begins.[21]",
        "Transition to subcutaneous insulin at least 30 minutes before stopping IV insulin. For pump users, restart the pump at least 60 minutes before IV insulin cessation after changing the cartridge, infusion set, and subcutaneous site.[21]"
      ],
      "subsections": [],
      "table": {
        "caption": "Findings that require immediate action during pediatric DKA treatment.[21]",
        "columns": [
          "Finding",
          "Concern",
          "Action"
        ],
        "rows": [
          [
            "Headache, agitation, bradycardia, or hypertension",
            "Possible cerebral edema",
            "Immediately assess neurologic status and prepare emergent therapy.[21]"
          ],
          [
            "Declining consciousness, abnormal breathing, cranial nerve findings, or unequal pupils",
            "Cerebral edema",
            "Give mannitol or hypertonic saline immediately; seek pediatric critical care input.[21]"
          ],
          [
            "Potassium <3 mmol/L",
            "High arrhythmia risk",
            "Consider pausing insulin and urgently intensify potassium management with critical care consultation.[21]"
          ],
          [
            "Glucose <108 mg/dL with persistent ketosis",
            "Insulin must continue for ketone clearance",
            "Increase IV dextrose; maintain insulin at least 0.05 units/kg/hour.[21]"
          ],
          [
            "Ketones not falling by 6-8 hours",
            "Inadequate insulin effect or ongoing problem",
            "Reassess treatment and consider increasing insulin infusion.[21]"
          ]
        ]
      }
    },
    {
      "id": "transition-and-prevention",
      "eyebrow": "After stabilization",
      "heading": "Prevent recurrent DKA with structured sick-day care and barrier assessment",
      "intro": "Recurrent DKA often reflects modifiable treatment, access, or psychosocial failure points.",
      "paragraphs": [
        "Before discharge after DKA in established diabetes, review the likely precipitant directly with the child or adolescent and caregivers. Insulin omission, lack of uninterrupted insulin access, intercurrent illness, and psychosocial stressors are major recurrence risks.[11][21] The diabetes team should provide individualized written sick-day instructions covering glucose and blood ketone monitoring, insulin adjustment, fluid and food intake, and thresholds for urgent contact or evaluation; revisit this plan at least annually.[21]",
        "Provide blood β-hydroxybutyrate strips and a meter, and advise ketone testing during illness or hyperglycemia. Blood ketone monitoring has practical advantages in young children and may identify metabolic deterioration earlier than urine testing.[11]",
        "Assess recurrent DKA for nonadherence sensitively and evaluate psychosocial well-being. Pediatric diabetes care should include access to multidisciplinary education, nutrition, mental health, and 24-hour clinical advice, with ongoing family involvement that is developmentally appropriate.[8][11][21]"
      ],
      "bullets": [
        "Ensure an uninterrupted supply of basal and rapid-acting insulin; insulin omission is a leading cause of DKA.[11]",
        "Review injection or infusion sites and device troubleshooting, particularly for pump users because interrupted rapid-acting insulin delivery can rapidly produce ketosis.[11]",
        "Screen for depression, anxiety, diabetes distress, eating disorders, family conflict, food insecurity, and financial barriers when glycemic control is poor or DKA recurs.[8][11]"
      ],
      "subsections": [],
      "table": {
        "caption": "Discharge-critical elements after pediatric DKA.[11][21]",
        "columns": [
          "Domain",
          "Required action",
          "Clinical purpose"
        ],
        "rows": [
          [
            "Sick-day plan",
            "Provide oral and written guidance on glucose and β-hydroxybutyrate monitoring, insulin adjustment, hydration, and escalation criteria.",
            "Reduce delayed recognition of ketosis and recurrent DKA.[21]"
          ],
          [
            "Ketone access",
            "Supply a blood ketone meter and unexpired strips.",
            "Enable illness and hyperglycemia assessment outside the hospital.[21]"
          ],
          [
            "Insulin access",
            "Verify access to uninterrupted insulin and delivery supplies.",
            "Insulin omission or inability to obtain insulin increases DKA risk.[11]"
          ],
          [
            "Psychosocial assessment",
            "Address recurrent DKA, adherence barriers, distress, family conflict, and social needs.",
            "Psychosocial factors can impair diabetes self-management.[8][11]"
          ]
        ]
      }
    }
  ],
  "faq": [
    {
      "question": "Can pediatric DKA occur with a normal glucose level?",
      "answer": "Yes. Children and adolescents already receiving insulin may develop DKA with normal blood glucose. Nausea, vomiting, abdominal pain, hyperventilation, dehydration, or altered consciousness should trigger blood ketone measurement and urgent evaluation.[21]"
    },
    {
      "question": "Should an IV insulin bolus be given in pediatric DKA?",
      "answer": "No. The cited pediatric DKA guideline recommends starting a continuous soluble insulin infusion 1-2 hours after IV fluids at 0.05-0.1 units/kg/hour and specifically advises against IV insulin boluses.[21]"
    },
    {
      "question": "When should dextrose be added during pediatric DKA treatment?",
      "answer": "Change to 0.9% sodium chloride with 5% dextrose when plasma glucose falls below 14 mmol/L (252 mg/dL). If glucose falls below 6 mmol/L (108 mg/dL) with persistent ketosis, increase IV glucose while continuing insulin.[21]"
    },
    {
      "question": "What findings should trigger empiric treatment for cerebral edema?",
      "answer": "Treat immediately when DKA is accompanied by declining consciousness, abnormal breathing, oculomotor palsy, or pupillary inequality or dilation. Headache, agitation, unexpected bradycardia, and hypertension are early warning signs requiring urgent assessment.[21]"
    },
    {
      "question": "When can intravenous insulin be stopped?",
      "answer": "Do not stop IV insulin until ketosis is resolving, the patient is alert, and oral fluids are tolerated without nausea or vomiting. Give subcutaneous insulin at least 30 minutes before discontinuing IV insulin; restart a pump at least 60 minutes before stopping IV insulin.[21]"
    }
  ],
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  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "highlights of prescribing information",
      "detail": "dailymed.nlm.nih.gov",
      "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=eaf135b6-e378-4f62-a1e7-db45e23668c7&type=display",
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      "snippet": "|  |  |  |  |\n ---  --- |\n| \\  Single dose unless otherwise noted.  †  Percent change (with/without coadministered drug and no change = 0%); ↑ and ↓ indicate the exposure increase and decrease, respectively.  ‡  AUC = AUC(INF) for drugs given as single dose and AUC = AUC(TAU) for drugs given in mult",
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      "title": "These highlights do not include all the information needed to use LEVEMIR® safely and effectively.See full prescribing information for LEVEMIR.\n      LEVEMIR® (insulin detemir) injection, for subcutaneous useInitial U.S. Approval: 2005",
      "detail": "dailymed.nlm.nih.gov",
      "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=82192527-99aa-4b53-8ce9-9173668d309c&type=display",
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      "snippet": "DRUG INTERACTIONS8 USE IN SPECIFIC POPULATIONS8.1 Pregnancy8.2 Lactation 8.4 Pediatric Use8.5 Geriatric Use8.6 Renal Impairment 8.7 Hepatic Impairment 10 OVERDOSAGE11 DESCRIPTION12 CLINICAL PHARMACOLOGY12.1 Mechanism of Action12.2 Pharmacodynamics12.3 Pharmacokinetics13 NONCLINICAL TOXICOLOGY13.1 Ca",
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    },
    {
      "number": 3,
      "title": "These highlights do not include all the information needed to use METFORMIN HYDROCHLORIDE TABLETS safely and effectively. See full prescribing information for METFORMIN HYDROCHLORIDE TABLETS.\n \n      \nMETFORMIN HYDROCHLORIDE tablets, for oral use\n \nInitial U.S. Approval: 1995",
      "detail": "dailymed.nlm.nih.gov",
      "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=bfd6ec0f-8264-4877-aa6d-f347f53bc426",
      "authors": "dailymed.nlm.nih.gov",
      "host": "dailymed.nlm.nih.gov",
      "snippet": "# INDICATIONS AND USAGE\n\nMetformin hydrochloride tablets, USP are a biguanide indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus. (\n1)\n\n# DOSAGE AND ADMINISTRATION\n\nAdult Dosage forMetformi",
      "score": 0.39747116
    },
    {
      "number": 4,
      "title": "rivaroxaban tablet, film coated XARELTO - DailyMed",
      "detail": "dailymed.nlm.nih.gov",
      "url": "https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=10db92f9-2300-4a80-836b-673e1ae91610",
      "authors": "dailymed.nlm.nih.gov",
      "host": "dailymed.nlm.nih.gov",
      "snippet": "Pediatric Use\n\nNo dosage adjustment is required in patients 1 year of age or older with mild renal impairment (eGFR 50 to ≤ 80 mL/min/1.73 m2). There are limited clinical data in pediatric patients 1 year or older with moderate or severe renal impairment (eGFR <50 mL/min/1.73 m2); therefore, avoid t",
      "score": 0.39319915
    },
    {
      "number": 5,
      "title": "Current Management of Type 1 Diabetes in Children: Guideline-based Expert Opinions and Recommendations",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11590761",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "This review article will focus on the main recommendations based on the ISPAD 2018-2022 guidelines (4), Hanas’ (3) book and the authors’ clinical experiences. Our aim is to bring to the attention of pediatric diabetes teams these apparently beneficial practices and to be the basis for a new countryw",
      "score": 0.61196244
    },
    {
      "number": 6,
      "title": "Diabetes (type 1 and type 2) in children and young people: ...",
      "detail": "www.nice.org.uk",
      "url": "https://www.nice.org.uk/guidance/ng18",
      "authors": "www.nice.org.uk",
      "host": "www.nice.org.uk",
      "snippet": "You are here:\n\n# Diabetes (type 1 and type 2) in children and young people: diagnosis and management\n\n## Overview\n\nThis guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends how to support children and young p",
      "score": 0.55565286
    },
    {
      "number": 7,
      "title": "Management of Newly Diagnosed Type 2 Diabetes ...",
      "detail": "pediatrics.aappublications.org",
      "url": "https://pediatrics.aappublications.org/content/131/2/364.short",
      "authors": "pediatrics.aappublications.org",
      "host": "pediatrics.aappublications.org",
      "snippet": "The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population.",
      "score": 0.51691306
    },
    {
      "number": 8,
      "title": "14. Children and Adolescents: Standards of Care in Diabetes ...",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9810473",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "161. Flynn JT, Kaelber DC, Baker-Smith CM, et al.; Subcommittee on Screening and Management of High Blood Pressure in Children . Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904. [DOI] [PubMed] [Google Scholar]",
      "score": 0.51530343
    },
    {
      "number": 9,
      "title": "Type 1 Diabetes Mellitus | Pediatrics In Review",
      "detail": "pedsinreview.aappublications.org",
      "url": "https://pedsinreview.aappublications.org/content/34/5/203",
      "authors": "pedsinreview.aappublications.org",
      "host": "pedsinreview.aappublications.org",
      "snippet": "All children with type 1 diabetes mellitus (T1DM) should have their blood sugar managed with basal-bolus insulin treatment by either multiple",
      "score": 0.4921643
    },
    {
      "number": 10,
      "title": "Type 1 Diabetes in Children",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK441918",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "5.\n\nTriolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK., Type 1 Diabetes TrialNet Study Group. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care. 2019 Feb;42(2):192-199. [PMC free article: PMC6341285] [PubMed: 300",
      "score": 0.4813325
    },
    {
      "number": 11,
      "title": "Type 1 Diabetes in Children and Adolescents - PMC - NIH",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6105320",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "110. Driscoll, Young-Hyman Use of technology when assessing adherence to diabetes self-management behaviors. _Curr Diab Rep_ 2014;14:521 doi: 10.1007/s11892-014-0521-1  [DOI] [PubMed] [Google Scholar]\n   111. Wolfsdorf, Allgrove, Craig, _et al._, International Society for Pediatric and Adolescent Di",
      "score": 0.4613328
    },
    {
      "number": 12,
      "title": "Diabetes in Children and Adolescents - Diabetes in America - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK619869",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Studies evaluating MASLD in youth with type 2 diabetes in the United States have generally been limited to measuring liver transaminases as surrogate markers for liver disease. Early work by Nadeau et al. used data from a comprehensive chart review at a pediatric diabetes clinic and reported that 48",
      "score": 0.4177708
    },
    {
      "number": 13,
      "title": "Pediatric Type 2 Diabetes - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK431046",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Physicians should have proficiency in diagnosis, medication management, and complication prevention. Nurses play a crucial role in patient education and ongoing monitoring. Pharmacists ensure appropriate medication selection and dosing. Open, transparent communication among team members is essential",
      "score": 0.3934788
    },
    {
      "number": 14,
      "title": "Pediatric Clinical Practice Guidelines & Policies",
      "detail": "reader.aappublications.org",
      "url": "https://reader.aappublications.org/pediatric-clinical-practice-guidelines-and-policies-18th-ed/1",
      "authors": "reader.aappublications.org",
      "host": "reader.aappublications.org",
      "snippet": "Clinical practice guidelines and policies from the American Academy of Pediatrics covering more than 40 clinical practice guidelines, plus every AAP policy.",
      "score": 0.36060217
    },
    {
      "number": 15,
      "title": "Standards of Medical Care in Diabetes—2021 Abridged for ...",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7839613",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "### Transition From Pediatric to Adult Care\n\n#### Recommendations\n\n13.110 Pediatric diabetes providers should begin to prepare youth for transition to adult health care in early adolescence and, at the latest, at least 1 year before the transition. E13.111 Both pediatric and adult diabetes care prov",
      "score": 0.35979196
    },
    {
      "number": 16,
      "title": "Management of Type 2 Diabetes Mellitus in Children and ...",
      "detail": "pediatrics.aappublications.org",
      "url": "http://pediatrics.aappublications.org/content/131/2/e648.full.html",
      "authors": "pediatrics.aappublications.org",
      "host": "pediatrics.aappublications.org",
      "snippet": "The AAP policy statement “Classifying Recommendations for Clinical Practice Guidelines”",
      "score": 0.3248246
    },
    {
      "number": 17,
      "title": "14. Children and Adolescents: Standards of Medical Care in ...",
      "detail": "diabetesjournals.org",
      "url": "https://diabetesjournals.org/care/article/45/Supplement_1/S208/138922/14-Children-and-Adolescents-Standards-of-Medical",
      "authors": "diabetesjournals.org",
      "host": "diabetesjournals.org",
      "snippet": "The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA's current clinical practice recommendations",
      "score": 0.32427868
    },
    {
      "number": 18,
      "title": "Screening for Prediabetes and Type 2 Diabetes Mellitus in ...",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK584383",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "This evidence review will be used by the United States Preventive Services Task Force (USPSTF) to make a recommendation on screening asymptomatic children and adolescents for prediabetes and type 2 diabetes. The USPSTF does not have a previous recommendation on this topic for children and adolescent",
      "score": 0.30994248
    },
    {
      "number": 19,
      "title": "Prevention and Treatment of Type 2 Diabetes Mellitus in ...",
      "detail": "pediatrics.aappublications.org",
      "url": "http://pediatrics.aappublications.org/content/112/4/e328.full",
      "authors": "pediatrics.aappublications.org",
      "host": "pediatrics.aappublications.org",
      "snippet": "these guidelines to improve the medical care for AI/AN children with type 2 diabetes mellitus and those at risk of and their families and",
      "score": 0.29910055
    },
    {
      "number": 20,
      "title": "Diabetes Care - American Diabetes Association",
      "detail": "diabetesjournals.org",
      "url": "https://diabetesjournals.org/care",
      "authors": "diabetesjournals.org",
      "host": "diabetesjournals.org",
      "snippet": "Standards of Care in Diabetes includes vital new and updated practice guidelines to care for people of all ages with diabetes and prediabetes.",
      "score": 0.22126693
    },
    {
      "number": 21,
      "title": "Recommendations | Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance | NICE",
      "detail": "www.nice.org.uk",
      "url": "https://www.nice.org.uk/guidance/ng18/chapter/recommendations",
      "authors": "www.nice.org.uk",
      "host": "www.nice.org.uk",
      "snippet": "##### 1.4.48\n\nMonitor children and young people having intravenous therapy for DKA using continuous electrocardiogram (ECG) to detect signs of hypokalaemia (including ST‑segment depression and prominent U‑waves). \n\n##### 1.4.49\n\nEnsure that healthcare professionals performing the monitoring describe",
      "score": 0.68191797
    },
    {
      "number": 22,
      "title": "Type 1 Diabetes Screening in Pediatrics",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatricsopenscience/article/2/2/1/207272/Type-1-Diabetes-Screening-in-Pediatrics-Putting",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "The 2026 update2 expands guidance on screening and monitoring, emphasizing the importance of early detection and intervention for those with a",
      "score": 0.5113512
    },
    {
      "number": 23,
      "title": "Diabetes Clinical Practice Guideline Quick Reference Tools",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/books/chapter-pdf/1328715/aap_9781610025034-part01-diabetes.pdf",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Clinicians must ensure that insulin therapy is initiated for children and adolescents with T2DM who are ketotic or in diabetic ketoacidosis",
      "score": 0.47387698
    },
    {
      "number": 24,
      "title": "Management of Type 1 Diabetes in Children in the ...",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatricsinreview/article/43/3/160/184775/Management-of-Type-1-Diabetes-in-Children-in-the",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Pediatricians should be aware of diabetes treatment advances, which can lead to optimal control of type I diabetes in the outpatient setting.",
      "score": 0.42821008
    }
  ],
  "publishedAt": "2026-08-21T00:05:39.140042Z",
  "updatedAt": "2026-08-21T00:05:39.140042Z",
  "readingMinutes": 5,
  "slug": "pediatric-diabetic-ketoacidosis"
}