Diabetic ketoacidosis (DKA) is a serious complication among pediatric population suffering from Diabetes Mellitus and it is associated with significant risk of life threatening complications resulting in increased morbidity and mortality. Overall the DKA management is well harmonized through recommended guidelines with a few emerging concerns relevant to the management and location of admissions for patients with different levels of severity of DKA , i.e. mild, moderate, severe. With emerging suggestions of revising the guidelines it is important to maintain the quality of care by careful evaluation of existing literature and properly designed future researches in pediatric population. Then to define the correct population of pediatric DKA patients who might be benefitted from the proposed revisions. Additionally, continuing awareness of primary health care providers is crucially important about the latest concepts as this can remarkably improve care in children having DM and DKA. Here is presented some literature review relevant to the emerging concerns with the aim to help improve quality of care. The aim of this article is to identify the controversies in management of DKA regarding managing patients in wards instead of PICU and intermittent insulin instead of insulin infusion, then to discuss the relevant basic patho-physiology, then it shall review the literature and lastly, to make suggestions regarding selection criteria of categories of patients who should be considered for non-insulin infusion therapy. These patients categories should be evaluated in future studies in order to achieve scientifically agreed consensus.
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