Endocrinology
DKA, growth and endocrine emergencies.
Use as a study guide only. These notes are part of a free open-access medical education (FOAMed) project and may contain errors or outdated information. Always verify against current guidelines (e.g. eTG, RACGP, local health district policies) and reputable sources before applying anything to patient care. See the full disclaimer.
From the wards
Clinical pearls & learnings
Tips and tricks collected over the years — a living list that grows with every rotation. Use as a study guide only and check current guidelines before acting on anything.
Diabetic ketoacidosis
Diabetic ketoacidosis
- Avoid aggressive fluid boluses unless genuinely shocked — rapid fluid shifts are associated with cerebral oedema, the leading cause of death in paediatric DKA.
- Aim for a controlled fall in glucose of roughly 5 mmol/L per hour, adding dextrose to the fluids as the glucose falls rather than stopping the insulin.
- Follow your local paediatric DKA protocol — the fluid and insulin regimens are prescriptive and vary between health services.
Steroid choice
Steroid choice: dexamethasone vs prednisolone vs hydrocortisone
| Agent | Duration | Notes |
|---|---|---|
| Dexamethasone | ~48 hours | Long-acting — convenient single/infrequent dosing |
| Prednisolone (Redipred) | ~24 hours | Needs a daily dose, typically for 3 days |
| Hydrocortisone | Short-acting | Avoid unless treating an Addisonian (adrenal) crisis — its mineralocorticoid activity raises blood pressure, which is unwanted outside adrenal insufficiency |