DKA & HHS Management Resources

Diabetic ketoacidosis is a complication of new or existing pediatric diabetes and may be complicated by cerebral injury. Due to this risk, is treated differently than adult DKA. Health care providers must follow a published pediatric-specific protocol when treating pediatric DKA. Early communication with the diabetes specialist at your pediatric referral site is a key element of the management of these patients.

These pediatric specific resources are divided into 2 phases:

1. TREKK: Healthcare Provider Resources (2023):
   • DKA Video
   • DKA Algorithm
   • DKA Pocket Card
   • DKA Order Set
   • DKA Bottom-Line Recommendations
   • DKA Evidence Repository
2. Ongoing inpatient management guidelines, intended for use after the immediate ED treatment (2023):
   • CPEG DKA Ongoing Management Algorithm (2023)

Please note that the TREKK guidelines are more prescriptive with respect to recommendations for fluids, insulin, etc. The inpatient management guidelines are intentionally more open, providing a range of acceptable options that will allow the clinician to adapt the care for a given patient and management preferences. We recommend communicating with your Pediatric Diabetes referral centre for advice and support as needed.

TREKK and CPEG have updated the DKA management guidelines to align with the ISPAD 2022 Clinical Practice Consensus Guidelines. With the 2023 DKA revisions, there are more liberal fluid rates and options and higher threshold for starting potassium, compared with our 2018 recommendations.

CPEG has also created a new document with guidelines for the management of hyperglycemic hyperosmolar state (HHS):

• CPEG Hyperglycemic Hyperosmolar State (HHS) Guidelines (2023)

See also the Canadian Paediatric Society's Practice Point Current Recommendations for Management of Paediatric Diabetic Ketoacidosis (2022).

We hope you find these resources helpful for you institution.