Anyone who works in the Emergency Department has seen patients brought in by EMS or sent from the clinic with a chief complaint of “high blood sugar.” Now, we are not talking about patients with diabetic ketoacidosis, but just simple hyperglycemia. This is a common complaint with no real consensus on optimal blood glucose levels before safe discharge.

IV fluids are classically associated with increased risk of cerebral edema in pediatric DKA. What is the literature behind this association? What mechanisms account for cerebral edema, and what should the emergency physician do?

In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can’t-miss diagnoses by age.

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management.

"The bolus insulin group had longer lengths of stay and a 6-fold increase in hypoglycemic episodes"

Anand Swaminathan, MD MPH (@EMSwami) addresses urban legends in DKA management, including VBGs vs ABGs, when to replete potassium, bicarb administration, and insulin boluses.