Signs and Symptoms
NOTE the presentations in pink - these are common paediatric presentations and can occur in a number of different disease processes. It is important to consider whether children presenting with these common symptoms may have diabetes as a cause.
The principles of treatment are simple:
- SLOWLY restore metabolic homeostasis
- Correct dehydration over 48 hours
- Reduce hyperglycaemia
- Switch off lipolysis (fat breakdown)
There are internationally agreed guidelines for the management of DKA in children. You do not need to remember these but you do need to know where to access them and ensure that you follow them.
- Initial approach (as per all emergency management)
- Airway: child may be profoundly drowsy, are they maintaining their airway?
- Breathing: normally not compromised and likely to be heavy, Kausmaul breathing to clear CO2 and relieve acidosis. Give 100% oxygen to all critically unwell children.
- Circulation: Fluid boluses should be used with extreme caution (see complications)
- DEFG (Don't Ever Forget Glucose): This may be the child's first presentation with diabetes, if you don't check the sugar you'll never know!
- Ongoing management
- Fluids: assess dehydration status, note observations and WEIGH THE CHILD as this is essential for calculating fluid volumes and insulin doses to prescribe.
- Insulin: Will likely require IV insulin. Make up insulin as per protocol and document all calculations
- Monitoring: including Pulse, respiratory rate, temp, BP, strict input/output, neuro observations