Pediatric Diabetic Ketoacidosis Follow-up

  • Author: Grace M Young, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Dec 14, 2009
 

Further Inpatient Care

  • Admit children with diabetic ketoacidosis (DKA) for further evaluation, observation, management, diabetes education, and assessment of compliance by responsible caretakers.
  • Assess the need for social service intervention.
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Transfer

  • Transfer to a pediatric intensive care unit is prudent for the patient with persistent altered mental status, resistant acidosis, and hemodynamic instability, and for the first-time newly diagnosed patient.
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Deterrence/Prevention

  • If the patient is known to have diabetes, maintain compliance with an insulin therapy regimen and close contact with the treating physician. This is especially important in the presence of nausea, vomiting, and abdominal pain.
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Complications

  • Cerebral edema
    • Cerebral edema occurs in 0.7-1% of children with diabetic ketoacidosis.
    • Causes are multifactorial but may include too-rapid infusion of fluids and electrolytes, overhydration, and overly aggressive correction of acidosis or hyperglycemia.
    • Treatment includes intubation, hyperventilation, and mannitol 0.25-1 g/kg intravenously.
  • Hypoglycemia
    • Causes include increased sensitivity to exogenous insulin and insufficient serum glucose for insulin to metabolize.
    • Treatment includes adding 5-10% dextrose to intravenous fluids when serum glucose level is 250-300 mg/dL.
  • Hypokalemia
    • Serum potassium begins to reflect actual total body potassium depletion as volume depletion and acidosis resolve.
    • Add potassium to intravenous fluids (see Emergency Department Care) when urine output is present and results of serum potassium level are available.
  • Cardiac dysrhythmia
    • Causes include hyperkalemia, hypokalemia, and hypocalcemia.
    • Treatment involves correcting the specific cause.
  • Pulmonary edema
    • Causes include low plasma oncotic pressure and increased pulmonary capillary permeability.
    • Treatment includes oxygen and diuresis.
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Prognosis

  • The prognosis is excellent if aggressive fluid and insulin therapy commence in the first few hours of diagnosis.
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Contributor Information and Disclosures
Author

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

James Li, MD  Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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Sample diabetic ketoacidosis flow sheet.
 
 
 
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