Hyperglycemia

Here are some resources for hyperglycemia based on our session today. First here are RMC’s DKA protocols for adults and pediatric patients.

• DKA Protocol_2016.06.11
• Peds DKA guidelines final 2013

Then some videos (old and new) about DKA and HHS.

2013 DKA and HHS

These video review diabetic ketoacidosis and hyperglycemic hyperosmolar states. The second one has some formulas that you should know exist.

Pediatric DKA

The management of DKA in children has some important differences, namely worrying about cerebral edema.

Of note, the PECARN network released an article in NEJM June 14, 2018 comparing fast and slow IV administration of 0.45% and 0.9% NS to determine who gets neurologic deficits. There were no differences between the groups.

1: Kuppermann N, Ghetti S, Schunk JE, Stoner MJ, Rewers A, McManemy JK, Myers SR, Nigrovic LE, Garro A, Brown KM, Quayle KS, Trainor JL, Tzimenatos L, Bennett JE, DePiero AD, Kwok MY, Perry CS 3rd, Olsen CS, Casper TC, Dean JM, Glaser NS; PECARN DKA FLUID Study Group. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018 Jun 14;378(24):2275-2287. doi: 10.1056/NEJMoa1716816. PubMed PMID: 29897851.