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A 2004 statement by the European Society for Paediatric Endocrinology and the Lawson Wilkins Pediatric Endocrine Society (for children) uses slightly different cutoffs, where mild DKA is defined by pH 7.20–7.30 (bicarbonate 10–15 mmol/L), moderate DKA by pH 7.1–7.2 (bicarbonate 5–10) and severe DKA by pH<7.1 (bicarbonate below 5). [31]
The most common causes of high anion gap metabolic acidosis are: ketoacidosis, lactic acidosis, kidney failure, and toxic ingestions. [3]Ketoacidosis can occur as a complication of diabetes mellitus (diabetic ketoacidosis), but can occur due to other disorders, such as chronic alcoholism and malnutrition.
The treatment of DKA in KPD is identical to the treatment of DKA caused by type 1 diabetes and revolves around fluid repletion, electrolyte repletion, and administration of insulin. [7] After the resolution of the DKA episode consideration of what patients to test for KPD should be considered.
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The procedure is to take the child's weight in pounds, divide by 150 lb, and multiply the fractional result by the adult dose to find the equivalent child dosage.For example, if an adult dose of medication calls for 30 mg and the child weighs 30 lb, divide the weight by 150 (30/150) to obtain 1/5 and multiply 1/5 times 30 mg to get 6 mg.
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The same principle is used in test strips that have been commercialized for the detection of diabetic ketoacidosis (DKA). These test strips use a beta-hydroxybutyrate-dehydrogenase enzyme instead of a glucose oxidizing enzyme and have been used to detect and help treat some of the complications that can result from prolonged hyperglycemia. [34]