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Pediatric Dka Guidelines 2017

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 >>

Ispad Clinical Practice Consensus Guidelines 2018 - International Society For Pediatric And Adolescent Diabetes

Ispad Clinical Practice Consensus Guidelines 2018 - International Society For Pediatric And Adolescent Diabetes

ISPAD Clinical Practice Consensus Guidelines 2018 The ISPAD Guidelines 2018 are now online! ISPADs Clinical Practice Consensus Guidelines are the only comprehensive set of clinical recommendations for children, adolescents, and young adults with diabetes worldwide! Authors include experts from across the globe and a chapter on limited care for developing healthcare systems has also been developed. Download your new ISPAD Guidelines below! The distribution of the ISPAD Guidelines 2018 is kindly supported by Lilly Diabetes*. *Lilly Diabetes had no influence on the contents or scope of the ISPAD Guidelines 2018 Editors: Carlo L. Acerini, Ethel Codner, Maria E. Craig, Sabine E. Hofer and David M. Maahs (Editor in Chief) Editorial: ISPAD Clinical Practice Consensus Guidelines 2018: What is New in Diabetes Care? Ethel Codner, Carlo L. Acerini, Maria E. Craig, Sabine E. Hofer and David M. Maahs Chapter 1: Definition, epidemiology, diagnosis andclassification of diabetes in children and adolescents Elizabeth J. Mayer-Davis, Anna R. Kahkoska, Craig Jefferies, DanaDabelea, Naby Balde,Chun Xiu Gong, Pablo Aschner and Maria E. Craig Chapter 2:Stages of type 1 diabetes in children andadolescents Jenny J Couper, Michael J Haller, Carla J Greenbaum, Anette-Gabriele Ziegler, DianeK Wherrett, MikaelKnip and Maria E Craig Chapter 3: Type 2 Diabetes mellitus in youth Phil Zeitler,Silva Arslanian,Junfen Fu, Orit Pinhas-Hamiel, Thomas Reinehr,Nikhil Tandon,Tatsuhiko Urakami, Jencia Wong and David M Maahs Chapter 4:The Diagnosis and management of monogenicdiabetes in children and adolescents Andrew T. Hattersley, Siri Atma W Greeley, Michel Polak, Oscar Rubio-Cabezas, Pl R Njlstad,Wojciech Mlynarski, Luis Castano, Annelie Carlsson,Klemens Raile, Dung Vu Chi, Sian Ellard andMaria E Craig Cha Continue reading >>

(pdf) Diabetic Ketoacidosis (dka): Treatment Guidelines

(pdf) Diabetic Ketoacidosis (dka): Treatment Guidelines

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 ... [Show full abstract] 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. This review deals with the two most serious side effects encountered with insulin pump therapy, severe hypoglycemia and diabetic ketoacidosis (DKA). Although clinical follow-up studies reported decreased rates of severe hypoglycemia, randomized studies have not confirmed this, showing no diff Continue reading >>

Update Regarding Diabetic Ketoacidosis In Children And Controversies In Management

Update Regarding Diabetic Ketoacidosis In Children And Controversies In Management

Update Regarding Diabetic Ketoacidosis In Children And Controversies In Management King Abdullah Specialized Childrens Hospital, King Abdullah International Medical and Research Center, King Abdulaziz Medical City Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia King Abdullah International Medical and Research Center King Abdullah Specialized Childrens Hospital King Abdulaziz Medical City Ministry of National Guard Health Affairs Submitted date: February 21, 2018; Accepted date: March 09, 2018; Published date: March 16, 2018 Visit for more related articles at Quality in Primary Care Diabetic ketoacidosis (DKA) is a serious complication among pediatric population suffering from Diabetes Mellitus and it is associated with significant risk of life threatening complications resulting in increased morbidity and mortality. Overall the DKA management is well harmonized through recommended guidelines with a few emerging concerns relevant to the management and location of admissions for patients with different levels of severity of DKA , i.e. mild, moderate, severe. With emerging suggestions of revising the guidelines it is important to maintain the quality of care by careful evaluation of existing literature and properly designed future researches in pediatric population. Then to define the correct population of pediatric DKA patients who might be benefitted from the proposed revisions. Additionally, continuing awareness of primary health care providers is crucially important about the latest concepts as this can remarkably improve care in children having DM and DKA. Here is presented some literature review relevant to the emerging concerns with the aim to help improve quality of care. The aim of this article is to identify the controversies in manage Continue reading >>

Diabetes In Childhood And Adolescence

Diabetes In Childhood And Adolescence

POCKETBOOK FOR MANAGEMENT OF IN UNDER-RESOURCED COUNTRIES 2 nd Edition 2017 The Pocket Book was prepared and edited by: • Dr. Graham Ogle, MBBS FRACP, General Manager, IDF Life for a Child Programme, Sydney Australia • Mrs. Angela Middlehurst, RN RSCN CDE, Education Manager, IDF Life for a Child Programme, Sydney Australia • Prof. Martin Silink, MBBS, MD, FRACP, Professor of Paediatric Endocrinology, University of Sydney and Chairman, IDF Life for a Child Programme and Sydney Australia • Assoc. Prof. Ragnar Hanas, MD, PhD, Uddevalla Hospital, NU Hospital Group, Uddevalla, Sweden (for ISPAD) For information on the IDF Life for a Child Programme see Chapter 16 and also www.idf.org/lifeforachild This Pocket book has been prepared and printed with financial support from the Leona M. and Harry B. Helmsley Charitable Trust and the Fondation de l’Orangerie. 2nd Edition, International Diabetes Federation, Brussels, 2017 Pocketbook for Management of Diabetes in Childhood and Adolescence in Under-Resourced Countries 2nd Edition 3 These guidelines have been developed taking into account resource- and cost-related issues affecting care for children and youth with diabetes in developing countries. Healthcare funding and available expertise vary from country to country and often also within a particular country, and therefore it is challenging to write a broad document to meet all needs. The information in these guidelines is aimed to assist health care professionals in developing countries to optimise the clinical practice they are able to give in their particular centre. In many cases, subsequent referral to a centre with greater expertise is appropriate. It is estimated that there are approximately 542,000 children under the age of 15 years with type Continue reading >>

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

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 treatment, infectious trigger, and lack of health insurance are risk factors for DKA.1,2,8 Even type 2 diabetics may experience DKA, with 5-25% of patients in DKA at time of diagnosis of type 2 diabetes.4,8,9 Insulin omission and infection are the most common sources for DKA.1,2 Pediatric DKA consists of hyperglycemia (serum glucose greater than 200 mg/dL), anion gap metabolic acidosis, and ketonemia.1,10-14 DKA is due to absolute or relative deficiency in insulin and excess counterregulatory hormones, with dehydration and electrolyte abnormalities. Rehydration with fluids, insulin, and potentia Continue reading >>

Review Of Evidence For Adult Diabetic Ketoacidosis Management Protocols

Review Of Evidence For Adult Diabetic Ketoacidosis Management Protocols

1Department of Endocrinology, Austin Health, Melbourne, VIC, Australia 2Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia 3Department of Intensive Care, Austin Health, Melbourne, VIC, Australia 4Menzies School of Health Research, Darwin, NT, Australia Background: Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs). Objective: To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management protocols and impact of DKA resolution rates on outcomes. Methods: Ovid Medline searches were conducted with limits “all adult” and published between “1973 to current” applied. National consensus statements were also reviewed. Eligibility was determined by two reviewers’ assessment of title, abstract, and availability. Results: A total of 85 eligible articles published between 1973 and 2016 were reviewed. The salient findings were (i) Crystalloids are favoured over colloids though evidence is lacking. The preferred crystalloid and hydration rates remain contentious. (ii) IV infusion of regular human insulin is preferred over the subcutaneous route or rapid acting insulin analogues. Administering an initial IV insulin bolus before low-dose insulin infusions obviates the need for supplemental insulin. Consensus-statements recommend fixed weight-based over “sliding scale” insulin infusions although evidence is weak. (iii) Potassium replacement is imperative although no trials compare replacement rates. (iv) Bicarbonate replacement 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 >>

Consensus Statements And Guidelines

Consensus Statements And Guidelines

ESPE - European Society of Paediatric Endocrinology ESPE Clinical Practice Committee Statements Consensus Statement on the Use of Gonadotropin-Releasing Hormone Analogs in Children Consensus Statement on the Diagnosis and Treatment of Children with Idiopathic Short Stature: A Summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop Growth Hormone Treatment and Risk of Solid Tumour Endorsed Consensus Statements and Guidelines Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline JCEM Aug 2015 100 (8) 2807 - 2831 Pharmacological Management of Obesity: An endocrine society clinical practice guideline JCEm feb 2015 100(2) 342 -362 Pediatric Obesity - Assessment, Treatment and prevention: An Endocrine Society Clinical Practice guideline JCEM 2017 102(3)709-757 Diagnosis and treatment of Primary Adrenal insufficiency: An endocrine Society Clinical guideline JCEM Feb 2016 101 (2) 364-389 Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer Thyroid 2015 25(7) 716 - 759 Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children J Paeds 2015 167 (2) 238 - 245 Continue reading >>

Pem Pearls: Treatment Of Pediatric Diabetic Ketoacidosis And The Two-bag Method

Pem Pearls: Treatment Of Pediatric Diabetic Ketoacidosis And The Two-bag Method

When insulin homeostasis is disrupted and decompensates, patients are at risk for developing diabetic ketoacidosis (DKA). All of the following criteria are required for a diagnosis of DKA: Treatment is based on a simple principle: return the bodys glucose regulation to its normal state and replace all of the things the body consumed while insulin-deficient. While bolus insulin is common in the treatment of DKA in adults, it is relatively contraindicated in the pediatric patient. Dehydration and secondary sympathetic activation can interfere with local tissue perfusion and may cause irregular and unpredictable absorption. If the patient has hypovolemic shock, crystalloid fluid boluses are indicated. However, many experts recommend expanding volume gradually to reduce the risk of cerebral edema. Step 2: Fluids, glucose, and insulin using the 2-Bag Method FLUIDS: Set total fluid rate at 1.5 X maintenance intravenous fluid rate (MIVF). The fluids come from 2 separate bags (saline bag, glucose bag). Institutions vary in the use of crystalloid formulations (NS, NS, or NS). Because the whole body is expected to be potassium depleted, 40 mEq/L of potassium should be added to the fluids*. A common combination is to use 20 mEq of K-Phosphate and 20 mEq of K-Acetate. Because KCl is an additional chloride load that can cause metabolic acidosis, it should be avoided or limited when possible. Other than glucose, it should have the same electrolyte composition as Bag #1. *NOTE on potassium: In severe DKA, the potassium can be profoundly low, and starting insulin before repleting potassium may precipitate symptomatic hypokalemia. Some experts recommend not starting insulin until the potassium has been corrected to above 3.0 mmol/L. If the initial measured potassium is elevated, or the 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 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 >>

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 >>

Dka Management In Children: Ada

Dka Management In Children: Ada

Diabetic ketoacidosis (DKA) is considered to be a common presentation of Type 1 Diabetes Mellitus (T1DM) and occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. DKA arises due to lack of adequate insulin in the body. Clinical Signs Dehydration (may be difficult to assess) Tachycardia, tachypnoea (may be mistaken for pneumonia or asthma) Kussmaul breathing with a typical fruity smell of ketones in the breath Nausea, vomiting (may be mistaken for gastroenteritis) Abdominal pain (may mimic an acute abdominal condition) Confusion, drowsiness, progressive reduction in level of consciousness, and eventually loss of consciousness. Investigations Serum glucose >200 mg/dL Serum bicarbonate <15 mEq/L or venous pH <7.3 Reduction in serum sodium of 2.4 mEq/L for every 100 mg/dL Potassium losses of 6–7 mEq/kg Negative phosphate balance Creatinine, BUN, blood gases, and hematocrit Blood Beta-hydroxybutyrate ≥31 mg/dL Urinalysis (for ketones) Electrocardiogram (ECG), if laboratory measurement of potassium status is delayed Diagnosis ISPAD in 2014 has defined the following biochemical criteria for the diagnosis of DKA: Hyperglycemia, blood glucose of >200 mg/dL, Metabolic acidosis, defined as a venous pH <7.3 or plasma bicarbonate <15 mEq/L, and Ketosis Severity of DKA: mild, moderate, or severe (pH 7.2–7.3; pH 7.1–7.2; or pH <7.1, respectively) Treatment Principles of DKA treatment: Replacement of fluid deficits Correction of dehydration Correction of acidosis and hyperglycemia Correction of electrolyte imbalance Treatment of any precipitating cause a. Fluid therapy: 0.9% normal saline or Ringer’s lactate, 10 mL/kg normal bolus for 1–2 hr. Continue ½ NS for 4–6 hr When the child becomes stable, switch to oral fluids After the first 48 hr, fluid ad Continue reading >>

Nice Diabetes In Children Guideline | Nice Guideline | Guidelines

Nice Diabetes In Children Guideline | Nice Guideline | Guidelines

have no insulin requirement, or have an insulin requirement of less than 0.5 units/kg body weight/day after the partial remission phase show evidence of insulin resistance (for example, acanthosis nigricans) Think about the possibility of types of diabetes other than types 1 or 2 (such as other insulin resistance syndromes, or monogenic or mitochondrial diabetes) in children and young people with suspected diabetes who have any of the following features: rarely or never develop ketone bodies in the blood (ketonaemia) during episodes of hyperglycaemia associated features, such as optic atrophy, retinitis pigmentosa, deafness, or another systemic illness or syndrome Do not measure C-peptide and/or diabetes-specific autoantibody titres at initial presentation to distinguish type 1 diabetes from type 2 diabetes Consider measuring C-peptide after initial presentation if there is difficulty distinguishing type 1 diabetes from other types of diabetes. Be aware that C-peptide concentrations have better discriminative value the longer the interval between initial presentation and the test Perform genetic testing if atypical disease behaviour, clinical characteristics or family history suggest monogenic diabetes Education and information for children and young people with type 1 diabetes Offer children and young people with type 1 diabetes and their family members or carers (as appropriate) a continuing programme of education from diagnosis. Ensure that the programme includes the following core topics: insulin therapy, including its aims, how it works, its mode of delivery and dosage adjustment blood glucose monitoring, including targets for blood glucose control (blood glucose and HbA1c levels) the effects of diet, physical activity and intercurrent illness on blood glucose con Continue reading >>

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