Pediatric Dka Guidelines 2017

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Pediatric Course | Fluids&Lytes- SIADH vs. DI vs. Cerebral Salt Wasting : https://goo.gl/forms/HcNRyu2bbObe5ELc2

Emdocs.net Emergency Medicine Educationa Well-grounded Myth? The Association Of Iv Fluids With Cerebral Edema In Pediatric Dka - Emdocs.net - Emergency Medicine Education

A Well-Grounded Myth? The Association of IV Fluids with Cerebral Edema in Pediatric DKA Author: Brit Long, MD (@long_brit, EM Attending Physician at SAUSHEC, USAF) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) A 5-year-old little girl presents with vomiting, polyuria, and polydipsia. She has a history of type 1 diabetes on insulin. Her mom called her endocrinologist, who recommended they come in to the ED. Her vital signs demonstrate tachycardia and hypotension, and she appears ill. You order a VBG, urinalysis, CBC, renal function, and lactate, and while you consider your rehydration strategy, the endocrinologist calls and asks you to do maintenance therapy only. The patient looks ill, with hemodynamic abnormalities. Whats the literature behind cerebral edema (CE) and fluid rehydration in pediatric DKA? This post will evaluate this topic and more. Type 1 and 2 diabetes mellitus is a common chronic disease among children.1-5 A major complication is DKA with a 25% incidence.3-8 Almost 1/3 of patients have DKA at the time of initial diabetes diagnosis.3-7 Younger age, smaller body mass index, delayed tr Continue reading >>

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  1. celeste03

    Ketones and weight loss

    Good morning! I've been a type 1 since I was 8 (I am 32 now) and I've always had ups and downs with weight. I've had ketones when losing weight before - and I've never gotten good answers from my doctors. They panic or think my blood tests are wrong (usually normal numbers with ketones) or tell me to eat more. I am around 275 pounds now (after losing 15 pounds) so I need to lose weight.
    I have a pump and a CGM (average bg on the cgm is around 128). Since starting the Cgm (a couple months ago) I rarely go above 200. My worst spikes are around 180.
    Last night, my blood sugar was around 72 before bed. That is lower than I want before bedtime so I had half a pack of fruit snacks. Usually my bg is very stable overnight so I wasn't worried. Around 1am I had an alarm that there was an impending low. I suspended the pump (temp basal for an hour). After an hour, it woke me up and my bg was around 65. So this time it auto suspended. I still wasn't concerned because the rate it fell wasn't quick and I thoight ok just have the pump suspend and it will fix itself (my normal rate overnight is 1.4u/hr). I know my basal rate is fine because every other night it's a flat line. I had some xtra exersize last night which I think was the issue. Anyway I did confirm the low with a meter.
    When I woke up around 5, I felt like my sugar was high. I did not feel good. The sensor said 117. My meter said 123. I felt high. So I checked for ketones. The color was at least moderate (40mg/dl)
    I know I had ketones because my pump was off for about 3 hours. But during this time my blood sugar never rose above 125. I confirmed the sensor with a finger poke so I know my blood sugar was fine. So my guess is they were starvation ketones. However, I have beeen eating carbs through the day. Not as many as I used to - but I am not low carbing.
    Are ketones like that (with symptoms) cause for concern with normal bg? Does it put me at more of a risk if my blood sugar were to rise? I'm just really.... frustrated and don't know what to do. I need to lose weight.
    My diet right now is a modified shake diet. I have a shake (ideal shake) for breakfast and maybe one more time a day if I'm hungry instead of snacking. I mix the shake with a banana and almond milk. Lunch is usually a lean protein and 2 vegetable servings. Dinner is usually similar, but I may have a piece of bread or half a roll. I am not calorie counting. I've done that before and i get burned out. I'm basically just trying to avoid high calorie density foods and eat vegetables when I am hungry. Or shakes (which have carbs). It's working so far - so I'm planning on keeping with it. If it stops working I'll do something more rigid like weight watchers or calorie counting. I'm not interested in anything where I have to cut entire foods out. I ate 1 cheese breadstick one night when the family got pizza. I want to be able to still have small indulgences sometimes . So paleo/atkins/etc are not an option.

  2. Jennifer72

    Do you own a copy of Dr. Bernstein's Diabetes Solution and Blood Sugar 101 by Jenny Ruhl?

  3. MarkM

    Having ketones just means that you are using fat for energy. Low carbers make ketones because they get most of their calories from fat. People losing weight make ketones because stored fat is used for energy. Ketones are a by-product of the process. Blood glucose does not need to be high for this to happen.
    If blood glucose is high, ketones are most likely because there is not enough circulation insulin for glucose to be metabolised. Blood glucose goes very high and the body switches to burning fat for energy. If too many ketones are produced because of this energy crisis, the blood becomes acidic. What they call diabetic ketoacidosis (DKA).
    Don't confuse normal ketosis with DKA. Ketosis is a useful and harmless process. Especially if you need to lose weight. As long as your insulin levels are adequate, you won't go into DKA.

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How to Present a Patient: Series for Medical Students Texas Tech University Health Sciences Center School of Medicine in Lubbock Ashley, 2 Weeks, Female

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 intensiv Continue reading >>

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  1. shecan1

    I keep hearing everyone being excited about being in deep Ketosis - when I get there I get an horrible headache that wont seem to go away - and I don't feel all that great. Am I not drinking enough water or taking the right kind of vitamins?

  2. Galoutofdixie

    Yes, I get the headache too and also some body aches and just a general unwell feeling. I think that is a normal part of getting into Ketosis. It's not called the "Atkins Flu" for nothing.
    It goes away in a couple of days, after your body has adjusted to using ketones as fuel instead of glucose. Hang tough and take asprin as needed and you should be feeling tip-top in a couple of days.
    Hope this helps a little.

  3. PoisonIvy

    It will go away after 2 days or so. I just take my naproxen. Its part of the induction flu. I go through it weekly since I do M/E mon-fri.
    Grats on reaching ketosis!! The extra energy, and not craving is worth a headache to me! But I had a head injury a few years ago, so headaches are pretty common for me.
    Maybe take something and lay down for a while?
    Hope your feeling better soon.

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

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 em Continue reading >>

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Popular Questions

  1. sakura_girl

    Originally posted by InTraining
    I am going through this very same thing right now. Except that I will go for 3 days without even a minute of sleep. It's so friggin' frustrating that I just want to beat the walls. I'm doing everything right to help myself, and I can't sleep. My heart races all night long.
    There has to be some answer but so far what I find is that everybody says the same old things and they never work - magnesium, calcium, carbs - nothing has helped me. Heart racing? That's indication to me of high cortisol and/or high caffeine levels when you're ready to sleep.

  2. Chaohinon

    You've lost 70 fracking pounds and only have 30 or 40 left to go?
    I know you don't want to hear it, but the catecholamine honeymoon is almost over. Now is the prime time to add in starches and fruits, and back off of fat a little (you still need some, just don't guzzle coconut oil and heavy cream).
    If that sounds like a bad idea, I recommend checking out Richard Nikoley's recent moderate starch experiment. If you look at the FitDay breakdown, he comes out with only 210g of carbohydrate at the end of the day, a measly 60 grams above Mark's carb pyramid ceiling - with more than enough quality fat and protein behind it.
    If you can manage to not binge on the fruit you eat each day, I refuse to believe you can't manage not to binge on potatoes. As long as you're not covering them in gobs of fat, it's really not an easy thing to accomplish - and this is coming from a world-class binge eater.
    Asking how to solve your insomnia without giving up chronic low-carbing is like asking how to nourish yourself without giving up anorexia. It's an inherently false premise and will lead you nowhere.

  3. rnikoley

    Originally posted by Chaohinon
    If you can manage to not binge on the fruit you eat each day, I refuse to believe you can't manage not to binge on potatoes. As long as you're not covering them in gobs of fat, it's really not an easy thing to accomplish - and this is coming from a world-class binge eater. FWIW, after 3-4 days on this I have found hunger to actually be less, not more as I expected. And yes, absolutely, upping the carbs by roughly 150g per day meant decreasing the fat and protein. I don't know why so many have a problem with this aspect.

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