Management of Ketoacidosis in Children

To the Editor: Dr. Madison (N Engl J Med 294:393-394, 1976) comments on the present controversy concerning dose and route of administration for insulin in ketoacidosis by stating that low-dose insulin should be considered a “research tool” and he recommends “no less than 15 U per hour preceded by a priming injection of 15 U [all by the intravenous route].” Unfortunately, such absolute statements can be tenaciously held in the mind of the busy practitioner and invoked by the unwary in any case of diabetic ketoacidosis regardless of the size of the patient. Although mortality from ketoacidosis in pediatric patients. . .