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Diabetic ketoacidosis (DKA) occurs when there is a relative or absolute decrease in circulating insulin levels in relation to an increase in counterregulatory hormone levels. In response to this imbalance, normal physiologic mechanisms are exaggerated, resulting in hyperglycemia, hyperosmolality, ketosis, and acidosis. (1) The biochemical criteria for the diagnosis of DKA are hyperglycemia (blood glucose level >200 mg/dL [>11.1 mmol/L]), venous pH less than 7.3 or serum bicarbonate level less than 15 mEq/L (<15 mmol/L), and ketonemia (blood β-hydroxybutyrate concentration ≥3 mmol/L) or moderate or severe ketonuria. (1)(2)(3)

Overall, the most common cause of DKA is new-onset type 1 diabetes mellitus (T1DM). DKA can also be seen in children with T1DM and infection, other intercurrent illness, or inadequate insulin administration. Children with type 2 diabetes mellitus (T2DM) may also present in DKA. High-dose...

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