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Dka In Pediatrics Ppt

25-40% Of Newly Diagnosed Cases Present In Dka

25-40% Of Newly Diagnosed Cases Present In Dka

Case Scenario #1 What is your assessment? DKA exists when: Venous pH < 7.3 Serum bicarbonate < 15 mEq/dL Blood glucose > 300 mg/dL Presence of ketonemia/ketonuria How much fluid would you administer as a bolus? Would you administer bicarbonate? How much insulin would you administer? What IVF would you start? At what rate? * 10 - 20 cc/kg bolus of NS would be adequate. Though the patient is dehydrated (dry lips), his hemodynamics are good, with acceptable vitals and good perfusion. There would be no reason to administer more than 20 cc/kg fluids. While this patient is clearly acidemic, he is NOT in impending cardiovascular collapse and therefore there is no justification for the administration of bicarbonate. In fact, administration of bicarbonate has been associated with the development of cerebral edema. The “true†serum sodium is 143 133 + 0.016[700-100] Insulin is generally started at 0.1 u/kg/hr. Therefore, in this 30 kg patient, an insulin infusion of 3 u/hr of regular insulin should be initiated. IVF of NS should be started at ~ 2400 cc/m2/day, which is approximately 1.5 x maintenance Continue reading >>

Review The Incidence And Pathophysiology Of Dka

Review The Incidence And Pathophysiology Of Dka

Diabetic Ketoacidosis in Children Keystone, July, 2008 Arleta Rewers MD, PhD Robert Slover MD Define the role of patient self-monitoring including blood ketones testing and the healthcare professional advice in preventing DKA Describe current approaches to the clinical diagnosis of DKA, including the role of ketone body levels List treatment options for DKA Definition Hyperglycemia BG > 200 mg/dl (11 mmol/l) (young or partially treated children, pregnant adolescents may present with “euglycemic ketoacidosisâ€) Venous pH <7.3 and/or bicarbonate <15 mmol/L mild DKA pH <7.3 bicarbonate <15 moderate pH <7.2 bicarbonate <10 severe pH <7.1 bicarbonate < 5 Glucosuria and ketonuria/ketonemia (β-HOB) Diabetic Ketoacidosis at Diagnosis of DM in Youth: The SEARCH for Diabetes in Youth Study Incidence of DKA at the time of diagnosis SEARCH is multicenter study In 2002 began population-based ascertainment of incident cases of DM in youth younger than 20 years Incidence: Overall - 25.5% (CI 23.9-27.1) Type 1 - 29.4 % ( CI 27.5-31.3%) Type 2 - 9.7% ( CI 7.1-12.2) Rewers A et al., Pediatrics, May 2008 DKA in children with established T1DM The risk of DKA varies from 1:10 to 1:100 /p-yr Poor metabolic control or previous DKA ï‚ risk Adolescent girls Children with psychiatric disorders, including those with eating disorders Lower socio-economic status Lacking appropriate insurance Inappropriate interruption of insulin pump therapy Predictors of Acute Complications in Children With Type 1 Diabetes A Rewers, HP Chase, T MacKenzie, P Walravens, M Roback M Rewers, RF Hamman, G Klingensmith 2002;287:2511-2518 Cohort of 1,243 diabetic children from BDC - age 0-19 years - residence in the six-county Denver area - outpatient visits between 1/1/1996 - 1/1/2001 Average follow-up 3.2 Continue reading >>

Acute Management Of Pediatric Diabetic Ketoacidosis

Acute Management Of Pediatric Diabetic Ketoacidosis

Acute Management of Pediatric Diabetic Ketoacidosis To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications. Introduction: This educational tool is a PowerPoint presentation that allows providers to quickly access guidelines for acute management of pediatric diabetic ketoacidosis (DKA). It was created after a chart review of pediatric patients with DKA determined that guidelines of DKA management were being incompletely followed. Methods: The resource contains recommendations from the American Diabetes Association guidelines, as well as a learning module consisting of a case scenario and three questions, each of which highlights important aspects of the care of pediatric patients with DKA.Session length should be no longer than 15 minutes. Results: Data are currently being collected on the reach of this educational tool. Discussion: The resource is limited by its short duration. It was deliberately designed to be readily accessible in a time-limited situation for initial care. Part of the education focuses on the complexity of pediatric patients with DKA, in the process making it clear that the three questions highlight only the most immediate clinical need. As a tool to be used in an acute care setting, this resource is adequate; however, a more comprehensive module with more detailed recommendations could be constructed for learners with less clinical experience. Barrios EK, Hageman J, Lyons E, et al. Current variability of clinical practice management of pediatric diabetic ketoacidosis in Illinois pediatric emergency departments. Pediatr Emerg Care. 2012;28(12):1307-13 Continue reading >>

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

INTRODUCTION Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM), with a case fatality rate ranging from 0.15 percent to 0.31 percent [1-3]. DKA also can occur in children with type 2 DM (T2DM); this presentation is most common among youth of African-American descent [4-8]. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) The management of DKA in children will be reviewed here (table 1). There is limited experience in the management and outcomes of DKA in children with T2DM, although the same principles should apply. The clinical manifestations and diagnosis of DKA in children and the pathogenesis of DKA are discussed elsewhere. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) DEFINITION Diabetic ketoacidosis – A consensus statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2014 defined the following biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) [9]: Hyperglycemia – Blood glucose of >200 mg/dL (11 mmol/L) AND Metabolic acidosis – Venous pH <7.3 or a plasma bicarbonate <15 mEq/L (15 mmol/L) AND Continue reading >>

Diabetic Ketoacidosis In Children

Diabetic Ketoacidosis In Children

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published by Ryan James Modified over 4 years ago Presentation on theme: "Diabetic Ketoacidosis in Children" Presentation transcript: 2 DKA Is the most common cause of hospitalization of children with diabetes Is the most common cause of death in children with diabetes Is fatal in <1% (from 1-2% of children in the 1970s) Most DKA deaths are attributable to cerebral edema (62-87%), which occurs in 0.4-1% of kids with DKA Ciordano B, Rosenbloom AL, Heller DR, et al: Regional services for children and youth with diabetes. Pediatrics. 1977;60: Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990;13:22-33. Edge J, Ford-Adams M, Dunger D. Causes of death in children with insulin-dependent diabetes Arch Dis Child. 1999;81: 3 Background Though it varies depending on the population, 20-40% of newly diagnosed T1DM patients are in DKA. Therefore, a major goal of outpatient diabetes management is to prevent DKA with a high index of suspicion with early DKA symptoms in new or established T1DM patients with close supervision of established patients Pinkney J et al. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. Diabetologia. 1994;37:70-74. G, Fishbein H, Ellis E. The epidemiology of diabetic acidosis: a population-based study. Am J Epidemiol. 1983;117:551 Always due to insulin deficiency--absolute or relative Many previously undiagnosed patients have been seen in pediatric offices or ERs where a detailed history and lab studies could make the diagnosis before DKA ensues A simple urine dip could be life-saving! High index of suspicion is especially important in infants and young chi Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Cerebral Edema And Diabetic Ketoacidosis

Cerebral Edema And Diabetic Ketoacidosis

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management. We recently discussed the use of mannitol and hypertonic saline for pediatric traumatic brain injury, but when should we consider these medications for the patient presenting with DKA? Cerebral Edema is a relatively rare. Incidence <1% of patients with DKA. Overall tends to occur in the newly diagnosed diabetic patient (4.3% vs 1.2%). While rare, it is a devastating complication. 1990 study showed case fatality rate was 64%. Those treated BEFORE respiratory failure had lower rate of mortality (30%). Lesson = treat early! The exact mechanism is not known… and may be varied between individual patients. Signs and Symptoms develop in: 66% within the first 7 hours of treatment (these tend to be younger). 33% within 10-24 hours of treatment. The diagnosis is clinical! ~40% of initial brain imaging of kids with cerebral edema are NORMAL! This is the area that often leads to finger pointing… most often those fingers being pointed toward the Emergency Physician who was initially caring for the kid. Much of the literature focused on interventions, but: Administration of Bicarb Sodium Bicarb was shown to be associated with Cerebral Edema in one study… Unfortunately, this study did not adjust for illness severity. Type of IV Fluids Generally, there is an absence of evidence that associates volume, tonicity, or rate change in serum glucose with Cerebral Edema development. There are cases presenting with cerebral edema prior to any therapies. Risk Factors that seem to stay consistent: Kids < 5 years of age More likely to have delayed diagnosis More severely ill at presentation S Continue reading >>

Case Presentation

Case Presentation

EM Registrar Case 12 year old male 1/12 fatigue Severe LOW 3/7 increasing SOB 1/7 confusion + lethargy Case Med Hx: Nil Chronic Medication: Nil Allergies: Nil known Multiple GP visits: fatigue due to puberty Case Clinically: Emaciated P 140 BP 70/40 RR 45 Temp 37.6°C Glucose: 36 mmol/l Acidotic breathing, shocked CNS – drowsy, but rousable, orientated to person, not place or time Other systems essentially normal Case Urine Ketones + UEC 129/ 5,2/ 9.3/ 108 ABG pH 7.05 pCO2 1.8 pO2 18 Bicarb 5.2 BE – 20 Case Problems New Type I DM DKA Hypovolaemic Shock Hyponatraemia Cerebral Oedema Management First bolus: 10ml/kg N/Saline – remained hypotensive Second bolus 10ml/kg N/Saline: still hypotensive, but ↑ confusion Concern about worsening cerebral oedema Fluid boluses stopped, commenced on fluid rehydration 0.45% Saline Admitted to ICU CT Brain: cerebral oedema Worsened over next 48 hrs, but eventually made complete recovery Case Type of fluid? Volume for resuscitation? Management of cerebral oedema in DKA? Predictors of cerebral oedema in DKA? Type of Fluid Normal (0.9%) Saline Generally recommended fluid1 Concerns about hyperchloraemic acidosis2 Ringers Lactate3 More hypotonic → increased risk cerebral oedema Lactate potentially metabolised to glucose Non-metabolised lactate can ↓ level of consciousness Contains potassium No evidence to support other crystalloids/ colloids for resuscitation Very little evidence overall for different fluids Best evidence for 0.9% Saline4 If not available, isotonic fluid Consider 0.45% saline for rehydration if hypernatraemic Volume for Resuscitation ≤ 10ml/kg boluses repeat to max 3 doses (30ml/kg)1,5 Fluid bolus not required if not shocked Fluid deficit replacement over 24-48 hrs Lower fluid Continue reading >>

Management Of Diabetic Ketoacidosis In Children And Adolescents

Management Of Diabetic Ketoacidosis In Children And Adolescents

Objectives After completing this article, readers should be able to: Describe the typical presentation of diabetic ketoacidosis in children. Discuss the treatment of diabetic ketoacidosis. Explain the potential complications of diabetic ketoacidosis that can occur during treatment. Introduction Diabetic ketoacidosis (DKA) represents a profound insulin-deficient state characterized by hyperglycemia (>200 mg/dL [11.1 mmol/L]) and acidosis (serum pH <7.3, bicarbonate <15 mEq/L [15 mmol/L]), along with evidence of an accumulation of ketoacids in the blood (measurable serum or urine ketones, increased anion gap). Dehydration, electrolyte loss, and hyperosmolarity contribute to the presentation and potential complications. DKA is the most common cause of death in children who have type 1 diabetes. Therefore, the best treatment of DKA is prevention through early recognition and diagnosis of diabetes in a child who has polydipsia and polyuria and through careful attention to the treatment of children who have known diabetes, particularly during illnesses. Presentation Patients who have DKA generally present with nausea and vomiting. In individuals who have no previous diagnosis of diabetes mellitus, a preceding history of polyuria, polydipsia, and weight loss usually can be elicited. With significant ketosis, patients may have a fruity breath. As the DKA becomes more severe, patients develop lethargy due to the acidosis and hyperosmolarity; in severe DKA, they may present with coma. Acidosis and ketosis cause an ileus that can lead to abdominal pain severe enough to raise concern for an acutely inflamed abdomen, and the elevation of the stress hormones epinephrine and cortisol in DKA can lead to an elevation in the white blood cell count, suggesting infection. Thus, leukocytosi Continue reading >>

Pediatric Type 1 Diabetes: Reducing Admission Rates For Diabetes Ketoacidosis

Pediatric Type 1 Diabetes: Reducing Admission Rates For Diabetes Ketoacidosis

Type 1 diabetes mellitus (T1DM) is a disorder in childhood and adolescence, which affects 1.54 per 1000 people younger than 20 years in the United States. 1 , 2 The incidence of T1DM is increasing worldwide 3 and has resulted in increased health care expenditures for patients with this disease. 1 Moreover, this expense is far greater when associated with complications associated with T1DM. The major acute T1DM complication in childhood is diabetes ketoacidosis (DKA). With poor glycemic control, these DKA episodes can be quite frequent resulting in emergency department visits and admissions to the intensive care unit. 4 DKA and other complications, like hypoglycemia, can be reduced by a comprehensive, multidisciplinary approach to disease management. Successful execution, using this approach, results in a significant reduction in patient morbidity and mortality as well as health care costs. 46 In addition, optimal glycemic control is critical for preventing and delaying long-term complications related to T1DM. 7 , 8 Recently, in the United Kingdom, adults with structured diabetes education and flexible basal-bolus insulin dosing regimens experienced a 61% reduction in risk for DKA and a 64% reduction in cost. 9 Finding comparable reductions in pediatric populations is important, as a study done previously by our group, in 2005, showed that 7% of children with T1DM were admitted for DKA and the cost per patient was $4730 for that year of care. 4 McEvilly and Kirk 6 showed that the use of a multidisciplinary team in the home setting resulted in lower costs when compared with hospital bed use for children with diabetes. A recent report demonstrated a reduction in costs without reducing quality of care in Medicaid pediatric patients with many chronic disorders using the Acc Continue reading >>

Episode 63 – Pediatric Dka

Episode 63 – Pediatric Dka

Pediatric DKA was identified as one of key diagnoses that we need to get better at managing in a massive national needs assessment conducted by the fine folks at TREKK – Translating Emergency Knowledge for Kids – one of EM Cases’ partners who’s mission is to improve the care of children in non-pediatric emergency departments across the country. You might be wondering – why was DKA singled out in this needs assessment? It turns out that kids who present to the ED in DKA without a known history of diabetes, can sometimes be tricky to diagnose, as they often present with vague symptoms. When a child does have a known history of diabetes, and the diagnosis of DKA is obvious, the challenge turns to managing severe, life-threatening DKA, so that we avoid the many potential complications of the DKA itself as well as the complications of treatment – cerebral edema being the big bad one. The approach to these patients has evolved over the years, even since I started practicing, from bolusing insulin and super aggressive fluid resuscitation to more gentle fluid management and delayed insulin drips, as examples. There are subtleties and controversies in the management of DKA when it comes to fluid management, correcting serum potassium and acidosis, preventing cerebral edema, as well as airway management for the really sick kids. In this episode we‘ll be asking our guest pediatric emergency medicine experts Dr. Sarah Reid, who you may remember from her powerhouse performance on our recent episodes on pediatric fever and sepsis, and Dr. Sarah Curtis, not only a pediatric emergency physician, but a prominent pediatric emergency researcher in Canada, about the key historical and examination pearls to help pick up this sometimes elusive diagnosis, what the value of serum Continue reading >>

The Management Of Diabetic Ketoacidosis In Children

The Management Of Diabetic Ketoacidosis In Children

Go to: Abstract The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort. Keywords: adolescents, cerebral edema, children, complications, diabetic ketoacidosis, fluid replacement, hypokalemia, management, prevention, recurrent DKA Go to: Introduction Definition of Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) is biochemically defined as a venous pH <7.3 or serum Continue reading >>

Low-dose Vs Standard-dose Insulin In Pediatric Diabetic Ketoacidosisa Randomized Clinical Trial

Low-dose Vs Standard-dose Insulin In Pediatric Diabetic Ketoacidosisa Randomized Clinical Trial

Importance The standard recommended dose (0.1 U/kg per hour) of insulin in diabetic ketoacidosis (DKA) guidelines is not backed by strong clinical evidence. Physiologic dose-effect studies have found that even lower doses could adequately normalize ketonemia and acidosis. Lowering the insulin dose may be advantageous in the initial hours of therapy when a gradual decrease in glucose, electrolytes, and resultant osmolality is desired. Objective To compare the efficacy and safety of low-dose insulin against the standard dose in children with DKA. Design, Setting, and Participants This was a prospective, open-label randomized clinical trial conducted in the pediatric emergency department and intensive care unit of a tertiary care teaching hospital in northern India from November 1, 2011, through December 31, 2012. A total of 50 consecutive children 12 years or younger with a diagnosis of DKA were randomized to low-dose (n = 25) and standard-dose (n = 25) groups. Interventions Low-dose (0.05 U/kg per hour) vs standard-dose (0.1 U/kg per hour) insulin infusion. Main Outcomes and Measures The primary outcome was the rate of decrease in blood glucose until a level of 250 mg/dL or less is reached (to convert to millimoles per liter, multiply by 0.0555). The secondary outcomes included time to resolution of acidosis, episodes of treatment failures, and incidences of hypokalemia and hypoglycemia. Results The mean (SD) rate of blood glucose decrease until a level of 250 mg/dL or less is reached (45.1 [17.6] vs 52.2 [23.4] mg/dL/h) and the mean (SD) time taken to achieve this target (6.0 [3.3] vs 6.2 [2.2] hours) were similar in the low- and standard-dose groups, respectively. Mean (SD) length of time to achieve resolution of acidosis (low vs standard dose: 16.5 [7.2] vs 17.2 [7.7] Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) A state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone. Can occur in both Type I Diabetes and Type II Diabetes In type II diabetics with insulin deficiency/dependence The presenting symptom for ~ 25% of Type I Diabetics. Hyperosmolar Hyperglycemic State (HHS) An acute metabolic complication of diabetes mellitus characterized by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. Occurs predominately in Type II Diabetics A few reports of cases in type I diabetics. The presenting symptom for 30-40% of Type II diabetics. Diagnostic Criteria for DKA and HHS Mild DKA Moderate DKA Severe DKA HHS Plasma glucose (mg/dL) > 250 > 250 > 250 > 600 Arterial pH 7.25-7.30 7.00-7.24 < 7.00 > 7.30 Sodium Bicarbonate (mEq/L) 15 – 18 10 - <15 < 10 > 15 Urine Ketones Positive Positive Positive Small Serum Ketones Positive Positive Positive Small Serum Osmolality (mOsm/kg) Variable Variable Variable > 320 Anion Gap > 10 > 12 > 12 variable Mental Status Alert Alert/Drowsy Stupor/Coma Stupor/Coma Causes of DKA/HHS Stressful precipitating event that results in increased catecholamines, cortisol, glucagon. Infection (pneumonia, UTI) Alcohol, drugs Stroke Myocardial Infarction Pancreatitis Trauma Medications (steroids, thiazide diuretics) Non-compliance with insulin Diagnostic Studies in DKA/HHS Chemistry ï‚ Glucose  Bicarbonate Anion gap = (Na+) – (Cl- + HCO3-) Frequently seen: ï‚ BUN/creatinine (dehydration) ï‚ potassium  sodium Pseudohyponatremia: to correct, add 1.6 mEq of sodium to every 100mg/dL of glucose above normal Serum acetones Positive in Continue reading >>

Pediatric Critical Care Medicine

Pediatric Critical Care Medicine

* Goals & Objectives Understand the action of insulin on the metabolism of carbohydrates, protein & fat Understand the pathophysiology of IDDM & DKA Understand the management approach to the patient with DKA Appreciate the complications that occur during treatment * Classification Type I (insulin-dependent diabetes mellitus, IDDM) Severe lacking of insulin, dependent on exogenous insulin DKA Onset in childhood ?genetic disposition & is likely auto-immune-mediated Type II (non-insulin-dependent diabetes mellitus, NIDDM) Not insulin dependent, no ketosis Older patient (>40), high incidence of obesity Insulin resistant No genetic disposition Increase incidence due to prevalence of childhood obesity IDDM: Epidemiology 1.9/1000 among school-age children in the US; 12-15 new cases/100,00 Equal male to female African-Americans: occurrence is 20-30% compared to Caucasian-Americans Peaks age 5-7 yrs and adolescence Newly recognized cases: more in autumn & winter Increase incidence in children with congenital rubella syndrome * Type I DM 15-70% of children with Type I DM present in DKA at disease onset 1/350 of type I DM will experience DKA by age 18 yo Risk of DKA increased by: Very young children Lower socioeconomic background No family history of Type I DM DKA: Most frequent cause of death in Type I DM One of the most common reasons for admission to PICU Decreased renal blood flow and glomerular perfusion Stimulates counter regulatory hormone release Dehydration Increased lactic acidosis Accelerated production of glucose and ketoacids Pt’s then have intestinal ileus causing vomiting and abdominal pain, which prevents them from keeping orally hydrated, and contributing to there dehydration * Type I DM: DKA Electrolytes loss Potassium: 3-5 mEq/kg Phosphate: 0.5-1.5 mmol/k Continue reading >>

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