Pediatric Diabetic Ketoacidosis Emergency Department Care Clinical Presentation

Updated: May 21, 2018
  • Author: Grace M Young, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Classic symptoms of diabetic ketoacidosis (DKA) are often absent in toddlers. If a patient has known diabetes, obtain a history for compliance with insulin regimens and the name of the patient's endocrinologist. Classic symptoms of DKA are as follows:

  • Often insidious

  • Fatigue and malaise

  • Nausea/vomiting

  • Abdominal pain

  • Polydipsia

  • Polyuria

  • Polyphagia

  • Weight loss

  • Fever



Physical examination may reveal the following:

  • Altered mental status without evidence of head trauma

  • Tachycardia

  • Tachypnea or hyperventilation (Kussmaul respirations)

  • Normal or low blood pressure

  • Increased capillary refill time

  • Poor perfusion

  • Lethargy and weakness

  • Fever

  • Acetone odor of the breath reflecting metabolic acidosis



Diabetic ketoacidosis is the presenting complaint in approximately one fourth of newly diagnosed patients with type 1 diabetes mellitus.

Infection is the most frequent cause of diabetic ketoacidosis, particularly in patients with known diabetes. Aggressive evaluation for infection is always warranted. Strongly consider empiric antibiotic therapy until cultures return.

Patient has poor compliance with existing insulin regimens.

Patient exhibits underlying endocrine changes of adolescence (thelarche, adrenarche, menarche).

Caregiver's lack of competence may be a cause.

Pump failure may occur (insulin pumps are increasingly in use).