Abstract *Corresponding author Jürgen Grulich-Henn, University of Heidelberg, Children´s Hospital, Division of General Pediatrics Im Neuenheimer Feld 430, D-69120 Heidelberg, Tel: 496221-568399; Fax: 496221-564126; Email: Juergen_ Submitted: 07 May 2018 Accepted: 22 May 2018 Published: 22 May 2018 Copyright © 2018 Grulich-Henn et al. OPEN ACCESS Keywords • Childhood diabetes; Diabetes mellitus Type 1; Ketoacidosis management Objective: Evaluation of the management and clinical outcome of children and adolescents with severe diabetic ketoacidosis. Methods: Patients admitted to the University Children´s Hospital Heidelberg with initial blood pH ? 7.0 were included in the study. Blood gas analyses, blood glucose and electrolytes were measured within the first 24 hours. The neurological status was evaluated by Glasgow coma scale (GCS). Requirements for insulin, fluid and potassium were recorded. Results: 13 patients (mean 12.0±4.62 years) with blood pH?7.0 were identified. Six were admitted with onset of type 1 diabetes. 77 % displayed mental alterations (GCS?12/15). Mean insulin dose within the first hours was 0.09 IU/kg/h, blood glucose declined by 66 mg/dl/h within the first 4 hours. Blood pH reached normal levels after 16 hours, while base deficits lasted for more than 24 hours. High doses of potassium were required (range: 0.02-0.60 mmol/kg/h) within the first 24 hours. No sodium bicarbonate was administered. None of the patients developed severe neurological complications. Conclusion: Treatment of severe diabetic ketoacidosis according to the international guidelines is safe and successful in routine clinical settings. There is no need for bicarbonate even in patients with initial pH ? 7.0.