Pediatric Diabetic Ketoacidosis Emergency Department Care Workup

Updated: May 21, 2018
  • Author: Grace M Young, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Workup

Laboratory Studies

Serum glucose level

Serum glucose (eg, Accu-Chek, Dextrostix) determination of hyperglycemia provides the opportunity for rapid diagnosis and treatment of diabetic ketoacidosis (DKA). However, a urine analysis (dip for sugar and ketones) is also acceptable.

Serum potassium level

This is the most important electrolyte disturbance in patients with severe diabetic ketoacidosis.

A patient with a low serum potassium level should be assumed to have a potentially life-threatening total body potassium level.

Patients with evidence of hypovolemia or history of polydipsia who have normal or high serum potassium level should be assumed to have moderate total potassium depletion.

Therapy should begin with volume resuscitation.

As a result of the potential for hypokalemia-induced malignant dysrhythmias, do not give insulin to patients known to have profound potassium depletion until potassium replenishment is underway.

ABG level

Venous blood gases are an alternative and may be kinder for patients.

Historically, venous pH has been believed to overestimate the degree of acidosis because of decreased intravascular volume and increased peripheral lactic acidosis. However, an adult study of patients with diabetic ketoacidosis concluded that venous blood gases accurately demonstrated the degree of acidosis.

Glycosylated hemoglobin

In a patient with known diabetes, high percentages of glycosylated hemoglobin (Hgb A1C) indicate poor compliance with insulin therapy.

CBC count

Note that an increased WBC count may be a response to stress in diabetic ketoacidosis and not necessarily a sign of infection.

Other studies

Other studies include the following:

  • Obtain serum sodium, chloride, bicarbonate, BUN, creatinine, magnesium, calcium, and phosphate levels

  • Urine glucose, ketones, and osmolality

  • Serum osmolality

  • Blood, urine, and throat cultures

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Imaging Studies

Obtain studies appropriate for suspected infection, obstructive abdominal processes, or cerebral edema.

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Other Tests

An ECG is especially helpful when results of serum potassium concentration are not rapidly available. Hyperkalemia causes peaked T waves and cardiac dysrhythmias.

Any studies appropriate for suspected infections, toxidromes, or other metabolic abnormalities may be performed.

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Procedures

Establish 2 large intravenous catheter lines for fluids, insulin infusion, drips, and further venous sampling (use distal isolated dedicated saline lock for the latter purpose, which is kinder to patients).

Arterial catheterization is performed if the following conditions are present:

  • Profoundly altered mental status

  • Signs of severe shock

  • Signs of severe acidosis

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