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Pediatric Diabetic Ketoacidosis Treatment & Management

Approach Considerations In patients with diabetic ketoacidosis, the first principals of resuscitation apply (ie, the ABCs [airway, breathing, circulation]). [3] Outcomes are best when children are closely monitored and a changing status is promptly addressed. [39, 2] Give oxygen, although this has no effect on the respiratory drive of acidosis. Diagnose by clinical history, physical signs, and elevated blood glucose. Fluid, insulin, and electrolyte (potassium and, in select cases, bicarbonate) replacement is essential in the treatment of diabetic ketoacidosis. Early in the treatment of diabetic ketoacidosis, when blood glucose levels are very elevated, the child can continue to experience massive fluid losses and deteriorate. Strict measurement of fluid balance is essential for optimal treatment. Continuous subcutaneous insulin infusion therapy using an insulin pump should be stopped during the treatment of diabetic ketoacidosis. Inpatient care Children with severe acidosis (ie, pH < 7.1) or with altered consciousness should be admitted to a pediatric intensive care unit. In cases in which the occurrence of diabetic ketoacidosis signals a new diagnosis of diabetes, the process of e Continue reading >>

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Popular Questions

  1. GMX

    I've been ketoing now almost 5 weeks but have been struggling to get my fasting blood glucose down. This morning my blood ketones registered at .8 but my blood glucose was 122. I'm eating about 90-100g protein a day but I weigh 217. Is it still just too much protein? Carb intake is negligible. Fat intake is probably 250g a day. Any thoughts? Thanks.

  2. Mare

    For your weight, that does not seem like a lot of protein to me. I weigh 145, and I've calculated my minimum protein at 60g and can go as high as 100g.
    As to blood glucose, there's a phenomenon with ketosis where fasting BG is elevated, but it is benign. Peter at Hyperlipid had a post on his blog some time ago that provided the science behind this, but I could not follow it. This may be what you're experiencing.

    My endo told me that this is true, and he goes by my A1C rather than my fasting because of this.

  3. carolT

    Protein could be lower if you are female (sorry, can't tell) and/or not exercising, but the ketone level indicates you are accessing some fat overnight.

    Have you taken glucose readings at night or before your main meal? Are they lower? You may be experiencing "dawn phenomenon" where glucose is higher in the morning because 1.) the same hormones that wake you up also give you some extra glucose to start the day or 2.) your glucose dropped overnight and your body reacts by making more of it. Also, if you happen to get up in the middle of the night, you could see what your glucose is doing before your normal waking time.

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