PedsCrit Diabetic Ketoacidosis with Dr. Nicole Glaser
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Oct 27, 2025 
Dr. Nicole Glaser, Chief of Pediatric Endocrinology at UC Davis, shares her expertise on managing pediatric diabetic ketoacidosis (DKA). She discusses best practices for triaging DKA patients and explains the critical risks associated with cerebral injury. Dr. Glaser highlights the importance of fluid management and the evidence supporting insulin infusion rates. She also addresses when to transition to subcutaneous insulin and the benefits of continuous glucose monitors in managing children recovering from DKA. Vigilant monitoring and reassessment are key takeaways.
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Favor Fixing Shock Over Fear Of Fluids
- Prioritize rehydration and correcting shock even if it means giving additional boluses beyond the first.
- Faster fluid arms in PCARN showed no detectable harm and possible faster mental-status recovery in very sick children.
Large Trial Shows No Harm From Faster Fluids
- The PECARN (PCARN) randomized fluid trial found no difference in neurologic outcomes across fluid types or rates.
- Trends suggested faster fluids might help the sickest kids, and no harm from faster rates was detected.
Limit Chloride Load When Possible
- Consider balanced fluids or acetate-containing potassium replacements to limit hyperchloremic acidosis.
- A randomized trial comparing LR/plasmalite to normal saline in DKA would be valuable.