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Pediatric Dka Guidelines 2016

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 >>

Management Of Paediatric Diabetic Ketoacidosis: An Audit

Management Of Paediatric Diabetic Ketoacidosis: An Audit

Introduction: NICE Guidelines NG18 (published 2015) advocate a more conservative approach to management of diabetic ketoacidosis (DKA) in children and young people up to the age of 18, in an attempt to reduce the risk of cerebral oedema. We aimed to assess if management of DKA in children at Manor Hospital was compliant with hospital guidelines, that were based on BSPED guidelines (issued 2009). We analysed the difference in total fluid administered if the new DKA guidelines were in place, specifically in the case of young people. Method: We retrospectively audited case notes of all patients up to the age of 19 years admitted to Walsall Manor Hospital with DKA between 1st July 2014–31st July 2015 (n=13). A standardised proforma was used to collect data, which was then analysed. Results: Current hospital policy advocates that young people after their 16th birthday are managed by the adult medical team. The adult DKA Guideline is based on recommendations of Joint British Diabetes Societies Inpatient Care Group recommendations (2013). The age range was 10 to 18 years. Ten patients were treated using the paediatric and three were treated using the adult guidelines. There was one significant fluid calculation error found in a patient treated with the paediatric guidelines, although the patient did not come to any harm. No fluid calculation error was found in those patients treated with adult guidelines, though one patient developed fluid overload not requiring active treatment. Mathematical modelling of fluid given in the first 12 hours of treatment shows that a young person would receive 40–70% less fluids if treated as per NICE NG18 instead of adult DKA Guidelines. In terms of other complications, there were 12 episodes of hypoglycaemia, but no episodes of hypokalaemia 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 >>

Children's Hospital Of Philadelphia

Children's Hospital Of Philadelphia

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us. ©2017 by Children's Hospital of Philadelphia, all rights reserved. Use of this site is subject to the Terms of Use. The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located. Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient. Continue reading >>

Pediatric Diabetic Ketoacidosistreatment & Management

Pediatric Diabetic Ketoacidosistreatment & Management

Pediatric Diabetic KetoacidosisTreatment & Management Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Timothy E Corden, MD more... 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. 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 education and support by the diabetes team should begin when the patient recovers. In cases in which diabetic ketoacidosis occurs in a child with established diabetes, explore the cause of the episode and take steps to prevent a recurrence. Following recovery from diabetic ketoacidosis, patients require subcutaneous insulin therapy. Edge JA, Roy Y, Bergomi A, et al. Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood g Continue reading >>

Diabetic Ketoacidosis In Children: Management

Diabetic Ketoacidosis In Children: Management

Diabetic Ketoacidosis in Children: Management CEREBRAL OEDEMA: DO WE REALLY KNOW THE CAUSE? We recently had a child with (diabetic ketoacidosis)DKA in our department and the subject of fluid resuscitation came up. Also the Queensland Government guidelines on the Emergency Management of children with DKA has recently been produced. I thought it was timely to revisit a blog I wrote in 2014 on the evidence on this topic, as well as set up a teaching module on DKA ( more on this at the end) Cerebral oedema is the most feared complication in children presenting with DKA. It occurs in about 1% of cases but has a mortality rate of up to 90% (Waldorf J et al Diabetes Care 2006; 29:1150-9). Patients will have a decreased conscious state and may also have cranial nerve palsies, headache and/or bradycardia and hypertension. Its incidence has remained the same since it was described in 1936 and although we have clues as to what may contribute to it, and we know that some patients have subclinical cerebral oedema even at presentation(Krane et al NEJM 1985;312:1147-51), we still cant predict who will get it, nor greatly affect its high rate of mortality. There are theories of causative factors, most of which are vasogenic or osmotically based, but the studies are small or retrospective, or both. One theory relates to osmolytes accumulating in brain cells. These are the compounds that maintain normal cell volumes. As extracellular osmolality decreases rapidly with treatment, water flows rapidly onto these cells causing the brain to swell. Another theory relates to Na+ / H+ exchanger, such that a correction of acidosis results in Na and water passing onto the brain cells, resulting in oedema. We believe that the following increase the chance of developing cerebral oedema: 3 Rapid chan 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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Runa Acharya, MD, University of Iowa-Des Moines Internal Medicine Residency Program at UnityPoint Health, Des Moines, IA. Udaya M. Kabadi, MD, FACP, FRCP(C), FACE, Veteran Affairs Medical Center and Broadlawns Medical Center, Des Moines, IA; Des Moines University of Osteopathic Medicine, Iowa City; and University of Iowa Carver College of Medicine, Iowa City; Adjunct Professor of Medicine and Endocrinology, University of Iowa, Iowa City, and Des Moines University, Des Moines. Peer Reviewer Jay Shubrook, DO, FAAFP, FACOFP, Professor, Primary Care Department, Touro University, College of Osteopathic Medicine, Vallejo, CA. To reveal any potential bias in this publication, and in accordance with Accreditation Council for Continuing Medical Education guidelines, we disclose that Dr. Farel (CME question reviewer) owns stock in Johnson & Johnson. Dr. Stapczynski (editor) owns stock in Pfizer, Johnson & Johnson, Walgreens Boots Alliance Inc., GlaxoSmithKline, Bristol Myers Squibb, and AxoGen. Dr. Wise (editor) reports he is on the speakers bureau for the Medicines Company. Dr. Kabadi (author) reports he is a consultant and on the speakers bureau for Sanofi. Dr. Shubrook (peer reviewer) reports he receives grant/research support from Sanofi and is a consultant for Eil Lilly, Novo Nordisk, and Astra Zeneca. Dr. Schneider (editor), Dr. Acharya (author), Ms. Coplin (executive editor), Ms. Mark (executive editor), Mr. Landenberger (editorial and continuing education director), and Mr. Springston (associate managing editor) report no financial relationships relevant to this field of study. EXECUTIVE SUMMARY Diabetic ketoacidosis typically occurs at the onset of Type 1 diabetes mellitus, but also may occur from withdrawal or omission of insulin therapy in patients due to psychiatric, Continue reading >>

Adherence To Pediatric Diabetic Ketoacidosis Guidelines By Community Emergency Departments Providers

Adherence To Pediatric Diabetic Ketoacidosis Guidelines By Community Emergency Departments Providers

Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments providers 2Department of Pediatrics, Section of Pediatric Hospital Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, ROC 4905, Indianapolis, IN 46202-5225 USA 1Section of Pediatric Critical Care Medicine, Indianapolis, IN USA 2Department of Pediatrics, Section of Pediatric Hospital Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, ROC 4905, Indianapolis, IN 46202-5225 USA Samer Abu-Sultaneh, Phone: 317-948-7185, Email: [email protected] . Received 2017 Jan 4; Accepted 2017 Mar 14. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines. We performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA. A total of 100 patients w Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

A Multicenter Retrospective Survey Regarding Diabetic Ketoacidosis Management In Italian Children With Type 1 Diabetes

A Multicenter Retrospective Survey Regarding Diabetic Ketoacidosis Management In Italian Children With Type 1 Diabetes

A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes Stefano Zucchini ,1 Andrea E. Scaramuzza ,2 Riccardo Bonfanti ,3 Pietro Buono ,4 Francesca Cardella ,5 Vittoria Cauvin ,6 Valentino Cherubini ,7 Giovanni Chiari ,8 Giuseppe dAnnunzio ,9 Anna Paola Frongia ,10 Dario Iafusco ,11 Giulio Maltoni ,1 Ippolita Patrizia Patera ,12 Sonia Toni ,13 Stefano Tumini ,14 Ivana Rabbone ,15and Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) 15 1Department of Pediatrics, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna, Italy 2Department of Pediatrics, Azienda Ospedaliera, Ospedale Luigi Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy 3Department of Pediatrics, Endocrine Unit, Scientific Institute Hospital San Raffaele, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy 4UOSD Pediatric Diabetology, ASL NA2 Nord, Via Corrado Alvaro 8, Monteruscello, 80072 Pozzuoli, Italy 5Department of Pediatrics, U.O.S. Pediatric Diabetology, ARNAS Civico Di Cristina, Via Benedettini 1, 90134 Palermo, Italy 6Pediatric Unit, S. Chiara Hospital, Largo Medaglie dOro 9, 38122 Trento, Italy 7Regional Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, AOU Salesi Hospital, Via Corridoni 11, 60123 Ancona, Italy 8Postgraduate School of Pediatrics, University of Parma, Viale Gramsci 14, 43100 Parma, Italy 9Clinica Pediatrica, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy 10Unit of Pediatric Diabetes, Brotzu Hospital, Piazzale Ricchi 1, 09134 Cagliari, Italy 11Department of Pediatrics, Second University of Naples, Via S. Andrea delle Dame 4, 80138 Naples, Italy 12Endocrinology and Diabetes Unit, Univers Continue reading >>

Ispad Clinical Practice Consensus Guidelines 2014

Ispad Clinical Practice Consensus Guidelines 2014

Editor in Chief: Mark A. Sperling, Pittsburgh, USA. Guest Editors: Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Introduction Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 1–3. Uploaded: 2. Sept 2014 Download Introduction Chapter 1: Definition, epidemiology, diagnosis and classification Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 4–17. Uploaded: 2. Sept 2014 Download Chapter 1 Chapter 2: Phases of Type 1 Diabetes Couper JJ, Haller MJ, Ziegler A-G, KnipM, Ludvigsson J, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 18–25. Download Chapter 2 Chapter 3: Type 2 diabetes Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Bartlett T, Maahs D. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 26-46. Uploaded: 2. Sept 2014 Download Chapter 3 Chapter 4: The Diagnosis and Management of Monogenic diabetes Rubio-Cabezas O, Hattersley AT, Njølstad PR, Mlynarski W, Ellard S,White N, Chi DV, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 47-64. Uploaded: 2. Sept 2014 Download Chapter 4 Chapter 5: Management of cystic fibrosis-related diabetes Moran A, Pillay K, Becker DJ, Acerini CL. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 65-76. Uploaded: 2. Sept 2014 Download Chapter 5 Chapter 6: Diabetes education Lange K, Swift P, Pankowska E, Danne T. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 77-85. Uploaded: 2. Sept 2014 Download Chapter 6 Chapter 7: The delivery of ambulatory diabetes care Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 86-101. Up Continue reading >>

Pediatric Office Emergencies Diabetic Ketoacidosis Treatment Protocol

Pediatric Office Emergencies Diabetic Ketoacidosis Treatment Protocol

Update 1/22/2016: Soonafter I initially postedthis entry I found an even more helpful podcast resource on pediatric diabetic ketoacidosis from Emergency Medicine Cases : Episode 63 Pediatric DKA . It turns out that in the pediatric office, the biggest challenge is diagnosing diabetic ketoacidosis in the child without a history of known Diabetes.What follows is from Reference (1) Episode 63 Pediatric DKA . In a child without a known history of diabetes, making the diagnosis of DKA can be difficult, especially in the mild cases where symptoms can be quite vague. If we dont have a high level of suspicion we can easily miss cases of early DKA. Thus, the diagnosis should be considered or ruled out if any of the following are present: Specific high risk groups (ie. Teenagers, children on insulin pumps and those from lower socio-economic status). Remember that glucose should be consideredthe sixth vital sign and any sick appearingchild should have a point of care glucose done! Once DKA is suspected, elements on history should focus on screening for symptoms of diabetes (polyuria, polydipsia, enuresis ,weight loss) as well as symptoms of DKA (nausea, vomiting, abdominal pain, decreased alertness). However, be sure to take the assessment one step further and consider any precipitating causes (viral or bacterial illness, social factors etc). What follows is also from Reference (1) Episode 63 Pediatric DKA show notes: 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 whos mission is to improve the care of children in non-pediatric emergency departments across the country. You might be wondering why Continue reading >>

Paediatric Dka Guideline 2015 Whats New?

Paediatric Dka Guideline 2015 Whats New?

Paediatric DKA Guideline 2015 Whats new? I put up the link to the revised BSPED DKA guideline recently, so I thought Id follow up with this post to explain exactly what all the changes are. Most of them relate to fluid management and seem to be geared towards making sure we dont end up overshooting with rehydration and putting kids in danger of cerebral oedema seems pretty reasonable In DKA, there is a hypertonicstate due to the massively elevated plasma glucose concentration. The theory is, that in order to avoid osmotic losses, brain cellsproduce osmotically active substances to counter the extra osmolality of the hypertonicplasma. If the plasma glucose concentration is corrected TOO FAST, not giving time for the osmotically active substances in the brain to dissipate, fluid gets drawn into the cells causing cerebral oedema. BSPED highlighted seven major updates mostly about fluid management that Ill explain briefly. The full guideline runs to 92 pages so probably not one to sit down to unless you have insomnia. 1. Change in degree of dehydration used to calculate fluids (5% deficit for moderate, 10% deficit for severe DKA, based on pH) According tothe 2015 guideline, pH below 7.1 = severe DKA. Kids with pH above 7.1 (mild to moderate DKA) should be assumed to be 5% dehydrated, and kids with pH below 7.1 should be assumed to be 10% dehydrated. This is a change from the previous 2009 guideline, which said that you shouldnt ever assume more than 8% dehydration. Now worried about over-hydrating these patients? Read on, as most of the other changes are all about controlling the total amount of fluids given. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. De-emphasise sodium chloride bolus at start of treatment (apart from sickest child Continue reading >>

Clinical Features And Diagnosis Of Diabetic Ketoacidosis In Children And Adolescents

Clinical Features And Diagnosis 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. Less commonly, it can occur in children with type 2 diabetes mellitus. DKA is caused by absolute or relative insulin deficiency. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) The incidence and prevalence of type 2 diabetes mellitus have increased across all ethnic groups. This has been coupled with an increasing awareness that children with type 2 diabetes mellitus can present with ketosis or DKA, particularly in obese African American adolescents [1-7]. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'DKA in type 2 diabetes'.) The clinical features and diagnosis of DKA in children will be reviewed here. This discussion is primarily based upon the large collective experience of children with type 1 diabetes mellitus. There is limited experience in the assessment and diagnosis of DKA in children with type 2 diabetes mellitus, although the same principles should apply. The management of diabetes in children, treatment of DKA in children and the epidemiology and pathogenesis of DKA are discussed separately. (See "Management of type 1 diabetes mellitus in children and adolescents" and "Treatment and complications 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 DKA [8]: Hyperglycemia – Blood glucose of >200 mg/dL (11 mmol/L) AND Continue reading >>

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