Paediatrics: Diabetic ketoacidosis

2021-03-09 12:00 AM

Diabetic ketoacidosis (DKA) is a diabetic emergency and such patients can die from hypovolaemic shock, cerebral oedema, hypokalaemia, or aspiration pneumonia.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a diabetic emergency and such patients can die from hypovolaemic shock, cerebral oedema, hypokalaemia, or aspiration pneumonia. DKA is defined as:

  • Hyperglycaemia (>11mmol/L).
  • pH < 7.3.
  • Bicarbonate <15mmol/L.
  • Urinary ketones.

Patients who meet the above criteria, who are more than 5% dehydrated, or who have an altered level of consciousness require careful supervision and treatment. Some patients may need a referral to an intensive care unit (e.g. pH < 7.1, severe dehydration with shock, <2yrs of age).

Clinical assessment

  • Degree of dehydration.
  • Level of consciousness.
  • Full examination for evidence of cerebral oedema, infection, and ileus.
  • Weight.

Investigations

The key tests are as follows.

Blood

  • FBC with differential.
  • Serum electrolytes with urea and creatinine.
  • Glucose.
  • LFTs (transaminases).
  • Arterial or capillary blood gas.
  • Lactate level.
  • Ketone level.

Urine

  • Urinalysis.
  • Ketones.
  • Reducing substances.
  • Organic and amino acids.
  • Drug screen.

Monitoring

  • Ensure the ABCs: after that, the form and type of monitoring will be dictated by the patient’s condition.
  • CNS: follow the neurological state. If there is a headache or altered consciousness, treat as though raised ICP has developed.
  • Continuous pulse oximetry and ECG monitoring: T-wave changes should alert you to hypokalaemia or hyperkalaemia.
  • Intermittent BP monitoring.
  • Hourly urine output: test for ketones.