Table 4 Guideline recommendations at a glance: adult vs. Pediatric hyperglycemic crises [20]
Aspect | Adults (ADA/International Consensus, JBDS) | Pediatrics (ISPAD) |
|---|---|---|
Diagnostic Criteria | DKA: Glucose > 250 mg/dL, pH < 7.3, HCO₃⁻ <18, ketonemia/uria. HHS: Glucose > 600 mg/dL, Osm > 320 mOsm/kg, no significant acidosis. | Similar to adult DKA criteria, but emphasizes BOHB ≥ 3.0 mmol/L. HHS is rare. |
Initial Fluids | 1–1.5 L isotonic saline over 1st hour. Replace 50% of deficit over first 12 h, remainder over next 12–24 h. | 10–20 mL/kg isotonic saline over 1–2 h. Slower, cautious rehydration over 36–48 h to prevent cerebral edema. |
Insulin Strategy | 0.1 unit/kg IV bolus, then 0.1 unit/kg/h infusion. Start after fluids/K + correction (> 3.3 mEq/L). | Contraindication of initial IV insulin bolus. Start infusion at 0.05–0.1 unit/kg/h after 1–2 h of fluids. |
Electrolyte Management | Aggressive K + replacement (if >3.3 mEq/L). Phosphate replacement only if < 1.0 mg/dL and cardiac/hemolytic/respiratory symptoms. | Similar aggressive K + replacement. Phosphate replacement for severe, symptomatic hypophosphatemia. |
Complication Prevention | Monitor for cerebral edema (rare in adults), thrombosis, ARDS. | High vigilance for cerebral edema. Monitor for mental status changes. |