Outpatient Management of Diabetic Ketoacidosis

• 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.

(AJDC 1988;142:448-450)