The vast majority of patients who present with DKA are sufficiently ill to require admission to the hospital for correction of fluid and electrolyte imbalances over a 24- to 72-h period. A very small and select group of patients can be considered for outpatient management of DKA, provided there is appropriate follow-up and supervision by the patient's parents and the treating physician. Patients with stable vital signs who can easily tolerate oral fluids and have minimal dehydration and electrolyte imbalances can be considered for discharge. Such patients still require 3 to 6 h of emergency department treatment to ensure clear documentation that clinical findings and laboratory values are improving. Most important, discharge instructions and follow-up should be carefully and cautiously coordinated between the caregivers and the patient's primary care physician.
However, the majority of patients with a past history of DKA need to be admitted to the hospital for ongoing therapy, treatment of underlying diseases that may have precipitated the DKA, and normalization of fluid and electrolyte levels. Patients with altered mental status, severe acidosis, or profound fluid and electrolyte deficits should be considered for management in the pediatric intensive care unit. Many hospitals have developed clinical treatment guidelines for patients with DKA, including criteria for admission to the intensive care unit.
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