Paediatrics: Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is a diabetic emergency and such patients can die from hypovolaemic shock, cerebral oedema, hypokalaemia, or aspiration pneumonia.
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).
- Degree of dehydration.
- Level of consciousness.
- Full examination for evidence of cerebral oedema, infection, and ileus.
The key tests are as follows.
- FBC with differential.
- Serum electrolytes with urea and creatinine.
- LFTs (transaminases).
- Arterial or capillary blood gas.
- Lactate level.
- Ketone level.
- Reducing substances.
- Organic and amino acids.
- Drug screen.
- 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.