{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:07:05Z","timestamp":1792177625041,"version":"4.4.0"},"reference-count":79,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T00:00:00Z","timestamp":1691107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and\/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia, and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed\/Medline and Scopus databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, between DKA and hyperosmolar hyperglycaemic state (HHS), and between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration, restoration of shifting electrolyte disorders and addressing underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention, and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.<\/jats:p>","DOI":"10.3390\/diagnostics13152602","type":"journal-article","created":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T10:21:39Z","timestamp":1691230899000},"page":"2602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-7537","authenticated-orcid":false,"given":"Eirini","family":"Kostopoulou","sequence":"first","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0878-0668","authenticated-orcid":false,"given":"Xenophon","family":"Sinopidis","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7617-9076","authenticated-orcid":false,"given":"Sotirios","family":"Fouzas","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despoina","family":"Gkentzi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Dassios","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stylianos","family":"Roupakias","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Dimitriou","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41572-020-0165-1","article-title":"Diabetic ketoacidosis","volume":"6","author":"Dhatariya","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/pedi.12773","article-title":"ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents","volume":"19","author":"Kahkoska","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic osmolar state","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1542\/peds.2013-2795","article-title":"Trends in the prevalence of ketoacidosis at diabetes diagnosis: The SEARCH for Diabetes in Youth Study","volume":"133","author":"Dabelea","year":"2014","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.2337\/dc09-0553","article-title":"Ketoacidosis at diabetes onset is still frequent in children and adolescents. A multicenter analysis of 14,664 patients from 106 institutions","volume":"32","author":"Neu","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.2337\/dc11-1980","article-title":"Is the frequency of ketoacidosis at onset of type 1 diabetes a child health indicator that is related to income inequality?","volume":"35","author":"Limenis","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/nrendo.2016.15","article-title":"Diabetic emergencies-ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia","volume":"12","author":"Umpierrez","year":"2016","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"350","DOI":"10.7326\/0003-4819-144-5-200603070-00011","article-title":"Narrative review: Ketosis-prone type 2 diabetes mellitus","volume":"144","author":"Umpierrez","year":"2006","journal-title":"Ann. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/dme.12875","article-title":"A national survey of the management of diabetic ketoacidosis in the UK in 2014","volume":"33","author":"Dhatariya","year":"2016","journal-title":"Diabet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1053\/ajem.2001.24473","article-title":"Rate and prediction of infection in children with diabetic ketoacidosis","volume":"19","author":"Flood","year":"2001","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/pedi.12165","article-title":"Diabetic ketoacidosis and hyperglycemic hypersmolar state","volume":"15","author":"Wolfsdorf","year":"2014","journal-title":"Pediatr. Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1111\/dme.13065","article-title":"Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: A national survey comparison of management in paediatric and adult settings","volume":"33","author":"Edge","year":"2016","journal-title":"Diabet. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"362","DOI":"10.15585\/mmwr.mm6712a3","article-title":"Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality-United States, 2000\u20132014","volume":"67","author":"Benoit","year":"2018","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJM200101253440404","article-title":"Risk factors for cerebral edema in children with diabetic ketoacidosis","volume":"344","author":"Glaser","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1007\/s00125-016-4034-0","article-title":"Risk of death following admission to a UK hospital with diabetic ketoacidosis","volume":"59","author":"Gibb","year":"2016","journal-title":"Diabetologia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"108838","DOI":"10.1016\/j.diabres.2021.108838","article-title":"Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis","volume":"175","author":"Cherubini","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/BF00428780","article-title":"Presentation and progress of childhood diabetes mellitus: A prospective population-based study","volume":"37","author":"Pinkney","year":"1994","journal-title":"Diabetologia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1056\/NEJMoa1716816","article-title":"PECARN DKA FLUID Study Group. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis","volume":"378","author":"Kuppermann","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3124","DOI":"10.2337\/dc14-0984","article-title":"Hyperosmolar hyperglycemic state: A historic review of the clinical presentation, diagnosis, and treatment","volume":"37","author":"Pasquel","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s13312-021-2255-x","article-title":"Low-dose (0.05 Unit\/kg\/hour) vs. Standard-Dose (0.1 Unit\/kg\/hour) Insulin in the Management of Pediatric Diabetic Ketoacidosis: A Randomized Double-Blind Controlled Trial","volume":"58","author":"Rameshkumar","year":"2021","journal-title":"Indian Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1136\/adc.2003.044875","article-title":"ESPE\/LWPES concensus statement on diabetic ketoacidosis in children and adolescents","volume":"89","author":"Dunger","year":"2004","journal-title":"Arch. Dis. Child."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/pedi.12268","article-title":"Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema","volume":"16","author":"Hsia","year":"2015","journal-title":"Pediatr. Diabetes"},{"key":"ref_23","first-page":"215","article-title":"Clinical utility of beta-hydroxybutyrate measurement in the management of physiological ketosis at home in children under 5","volume":"90","author":"Vanelli","year":"2019","journal-title":"Acta Biomed."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1542\/peds.2007-1105","article-title":"Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: The Search for Diabetes in Youth Study","volume":"121","author":"Rewers","year":"2008","journal-title":"Pediatrics"},{"key":"ref_25","first-page":"223","article-title":"Fighting obesity in children from European World Health Organization member states. Epidemiological data, medical-social aspects, and prevention programs","volume":"170","author":"Nittari","year":"2019","journal-title":"Clin. Ter."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/dme.12757","article-title":"Joint British Diabetes Societies (JBDS) for Inpatient Care & jbds Hyperosmolar Hyperglycaemic Guidelines Group. Management of hyperosmolar hyperglycaemic state in adults with diabetes","volume":"32","author":"Scott","year":"2015","journal-title":"Diabet. Med."},{"key":"ref_27","first-page":"l1114","article-title":"Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: Review of acute decompensated diabetes in adult patients","volume":"365","author":"Donihi","year":"2019","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jpeds.2009.10.001","article-title":"Is diabetic ketoacidosis at disease onset a result of missed diagnosis?","volume":"156","author":"Bui","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1440-1754.2009.01657.x","article-title":"Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China","volume":"46","author":"Xin","year":"2010","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1053\/jcrc.2002.33030","article-title":"Abdominal pain in patients with hyperglycemic crises","volume":"17","author":"Umpierrez","year":"2002","journal-title":"J. Crit. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.2337\/dc09-9032","article-title":"Hyperglycemic crises in adult patients with diabetes","volume":"32","author":"Kitabchi","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1900\/RDS.2016.13.217","article-title":"Blood ketones: Measurement, interpretation, limitations and utility in the management of diabetic ketoacidosis","volume":"13","author":"Dhatariya","year":"2016","journal-title":"Rev. Diabet. Stud."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"926","DOI":"10.2337\/diab.29.11.926","article-title":"Effects of acute insulin deficiency on glucose and ketone body turnover in man: Evidence for the primacy of overproduction of glucose and ketone bodies in the genesis of diabetic ketoacidosis","volume":"29","author":"Miles","year":"1980","journal-title":"Diabetes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/dme.12136","article-title":"Blood \u03b2-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in type 1 diabetes: A systematic review","volume":"30","author":"Klocker","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/j.1399-5448.2009.00569.x","article-title":"Diabetic ketoacidosis in children and adolescents with diabetes","volume":"10","author":"Wolfsdorf","year":"2009","journal-title":"Pediatr. Diabetes"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/(SICI)1520-7560(199911\/12)15:6<412::AID-DMRR72>3.0.CO;2-8","article-title":"Ketone bodies: A review of physiology, pathophysiology and application of monitoring to diabetes","volume":"15","author":"Laffel","year":"1999","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_37","first-page":"306","article-title":"Possible mechanism for cerebral oedema in diabetic ketoacidosis","volume":"2","author":"Klip","year":"1987","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1001\/archpedi.1994.02170100044009","article-title":"Physiologic management of diabetic ketoacidemia: A 5-year prospective pediatric experience in 231 episodes","volume":"148","author":"Harris","year":"1994","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S0887-8994(99)00079-X","article-title":"Risk factors for developing brain herniation during diabetic ketoacidosis","volume":"21","author":"Mahoney","year":"1999","journal-title":"Pediatr. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0022-3476(88)80521-3","article-title":"Factors associated with brain herniation in the treatment of diabetic ketoacidosis","volume":"113","author":"Duck","year":"1988","journal-title":"J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2337\/diacare.13.1.22","article-title":"Intracerebral crises during treatment of diabetic ketoacidosis","volume":"13","author":"Rosenbloom","year":"1990","journal-title":"Diabetes Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0024-3205(93)90668-S","article-title":"Brain osmoregulation during extreme and moderate dehydration in a rat model of severe DKA","volume":"53","author":"Harris","year":"1993","journal-title":"Life Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s13312-020-1777-y","article-title":"Cerebral edema in diabetic ketoacidosis\u2014Fluid shifts and shifting paradigms","volume":"57","author":"Araya","year":"2020","journal-title":"Indian Pediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/PEC.0000000000001550","article-title":"Resuscitation with Ringer\u2019s Lactate compared with normal saline for pediatric diabetic ketoacidosis","volume":"37","author":"Bergman","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1172\/JCI103352","article-title":"The effect in humans of extracellular pH change on the relationship between serum potassium and intracellular potassium","volume":"35","author":"Burnell","year":"1956","journal-title":"J. Clin. Investig."},{"key":"ref_46","unstructured":"EL-Mohandes, N., Yee, G., Bhutta, B.S., and Huecker, M.R. (2023, January 31). Pediatric Diabetic Ketoacidosis, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470282\/?report=classic)."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9343(99)00055-8","article-title":"Hyponatremia: Evaluating the correction factor for hyperglycaemia","volume":"106","author":"Hillier","year":"1999","journal-title":"Am. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e2021050243","DOI":"10.1542\/peds.2021-050243","article-title":"Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group. Serum Sodium Concentration and Mental Status in Children with Diabetic Ketoacidosis","volume":"148","author":"Glaser","year":"2021","journal-title":"Pediatrics"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2337\/diacare.24.1.131","article-title":"Management of hyperglycemic crises in patients with diabetes","volume":"24","author":"Kitabchi","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1136\/adc.83.6.514","article-title":"Chasing the base deficit: Hyperchloraemic acidosis following 0.9% saline fluid resuscitation","volume":"83","author":"Skellett","year":"2000","journal-title":"Arch. Dis. Child."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4239\/wjd.v9.i11.199","article-title":"Use of sodium bicarbonate and blood gas monitoring in diabetic ketoacidosis: A review","volume":"9","author":"Patel","year":"2018","journal-title":"World J. Diabetes"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2690","DOI":"10.1097\/00003246-199912000-00014","article-title":"Does bicarbonate therapy improve the management of severe diabetic ketoacidosis?","volume":"27","author":"Viallon","year":"1999","journal-title":"Crit. Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/pedi.12701","article-title":"ISPAD clinical practice consensus guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state","volume":"19","author":"Wolfsdorf","year":"2018","journal-title":"Pediatr. Diabetes"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/dmrr.2653","article-title":"Continuous subcutaneous insulin infusion in diabetes: Patient populations, safety, efficacy, and pharmacoeconomics","volume":"32","author":"Pozzilli","year":"2016","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00592-019-01326-5","article-title":"Continuous subcutaneous insulin infusion vs. modern multiple injection regimens in type 1 diabetes: An updated meta-analysis of randomized clinical trials","volume":"56","author":"Pala","year":"2019","journal-title":"Acta Diabetol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/pedi.12121","article-title":"Insulin pump use in young children in the T1D exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy","volume":"15","author":"Blackman","year":"2014","journal-title":"Pediatr. Diabetes"},{"key":"ref_57","unstructured":"Healthcare Quality Improvement Partnership, and Royal College of Paediatrics and Child Health (2017, July 31). National Paediatric Diabetes Audit Report. 2012\u20132015: Part 2. Hospital Admissions and Complications. Royal College of Paediatrics and Child. Health. Available online: https:\/\/www.rcpch.ac.uk\/sites\/default\/files\/2018-03\/npda_hospital_admissions_report_part_2_2012-15.pdf."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1111\/pedi.13377","article-title":"Insulin pump therapy is associated with higher rates of mild diabetic ketoacidosis compared to injection therapy: A 2-year Swedish national survey of children and adolescents with type 1 diabetes","volume":"23","author":"Wersall","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1001\/jama.2017.13994","article-title":"Association of Insulin Pump Therapy vs. Insulin Injection Therapy with Severe Hypoglycemia, Ketoacidosis, and Glycemic Control among Children, Adolescents, and Young Adults with Type 1 Diabetes","volume":"318","author":"Karges","year":"2017","journal-title":"JAMA"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1089\/dia.2019.0097","article-title":"Continuous Subcutaneous Insulin Infusion in Adult Type 1 Diabetes Mellitus Patients: Results from a Public Health System","volume":"21","author":"Gomez","year":"2019","journal-title":"Diabetes Technol. Ther."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1053\/j.ackd.2021.05.001","article-title":"Sodium-Glucose transporter inhibition in pediatric type 1 diabetes mellitus","volume":"28","author":"Vitale","year":"2021","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ndt\/gfz230","article-title":"Renal physiology of glucose handling and therapeutic implications","volume":"35","author":"Cherney","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.tips.2010.11.011","article-title":"Renal glucose reabsorption inhibitors to treat diabetes","volume":"32","author":"Bailey","year":"2011","journal-title":"Trends Pharmacol. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1093\/ndt\/gfz228","article-title":"Role of sodium-glucose cotransporter 2 inhibition to mitigate diabetic kidney disease risk in type 1 diabetes","volume":"35","author":"Bjornstad","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes","volume":"373","author":"Zinman","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMoa1812389","article-title":"Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes","volume":"380","author":"Wiviott","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.2337\/dc15-0843","article-title":"Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment with Sodium-Glucose Cotransporter 2 Inhibition","volume":"38","author":"Peters","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.2337\/dc18-2316","article-title":"International Consensus on Risk Management of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Treated with Sodium-Glucose Cotransporter (SGLT) Inhibitors","volume":"42","author":"Danne","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1111\/dom.13811","article-title":"Sodium-glucose co-transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol","volume":"21","author":"Goldenberg","year":"2019","journal-title":"Diabetes Obes. Metab."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4239\/wjd.v6.i1.167","article-title":"Rare complications of pediatric diabetic ketoacidosis","volume":"6","author":"Bialo","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/0140-6736(90)91587-Z","article-title":"Cerebral oedema in diabetic ketoacidosis in children","volume":"336","author":"Bello","year":"1990","journal-title":"Lancet"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jemermed.2017.03.014","article-title":"Emergency medicine myths: Cerebral edema in pediatric diabetic ketoacidosis and intravenous fluids","volume":"53","author":"Long","year":"2017","journal-title":"J. Emerg. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2337\/diacare.27.7.1541","article-title":"Cerebral edema in childhood diabetic ketoacidosis: Natural history, radiographic findings, and early identification","volume":"27","author":"Muir","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1056\/NEJM198505023121803","article-title":"Subclinical brain swelling in children during treatment of diabetic ketoacidosis","volume":"312","author":"Krane","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e2025481","DOI":"10.1001\/jamanetworkopen.2020.25481","article-title":"Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group; Frequency and risk factors of acute kidney injury during diabetic ketoacidosis in children and association with neurocognitive outcomes","volume":"3","author":"Myers","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Huang, S.K., Huang, C.Y., Lin, C.H., Cheng, B.W., Chiang, Y.T., Lee, Y.C., Yeh, S.N., Chan, C.I., Chua, W.K., and Lee, Y.J. (2020). Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239160"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1007\/s00467-023-05878-1","article-title":"Incidence, predictors, and short-term outcomes of acute kidney injury in children with diabetic ketoacidosis: A systematic review","volume":"38","author":"Meena","year":"2023","journal-title":"Pediatr. Nephrol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1164946","DOI":"10.3389\/fped.2023.1164946","article-title":"Editorial: Diabetic ketoacidosis in children and adolescents: From epidemiological data to clinical aspects","volume":"11","author":"Zucchini","year":"2023","journal-title":"Front. Pediatr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1001\/jamapediatrics.2021.5038","article-title":"Association of acute kidney injury during diabetic ketoacidosis with risk of microalbuminuria in children with Type 1 diabetes","volume":"176","author":"Huang","year":"2022","journal-title":"JAMA Pediatr."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/15\/2602\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:26:06Z","timestamp":1760127966000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/15\/2602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,4]]},"references-count":79,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["diagnostics13152602"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13152602","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,4]]}}}