Diabetes

Question 1

What glucose level in the blood is considered hypoglycemic in pediatrics?
When lower than that level, what are the severe consequences that may arise?

Answer 1

<4mmol/L
May cause loss of consciousness, seizures, and comas

Question 2

What are the main symptoms of DKA to look out for?

Answer 2

Polydypsia
Polyuria
Abdominal pain
vomiting
Kussmaul breathing
sweet breath (acetone)

Question 3

In a communication station on diabetes? What would be some important things to bring up?

Answer 3

How often and when they check their blood glucose levels
Insulin taken on time (after meals) with checking after
Appropriate meals and snacks, avoiding high sugar foods

Question 4

What are some results of laboratory tests that may indicate DKA?

Answer 4

Glucose >11mmol/L
Acidosis => pH <7.3
Ketone levels >1.5

Question 5

What are the long term consequences of diabetes?

Answer 5

Retinopathy, nephropathy, neuropathy (painful limbs and diabetic foot ulcers)

Question 6

There is a newly diagnosed child with Type 1 Diabetes. How much insulin would you give?

Answer 6

<5 = 0.5 units/kg/day
<12 = 0.75 units/kg/day
>12 = 1 unit/kg/day

Question 7

In an emergency station, how is the glucose level obtained?

Answer 7

Glucometer

Question 8

How are ketones made?

Answer 8

When the body cannot use glucose (either due to malnutrition, insulin desensitization, or gastroenteritis/malabsorption), it will break down fat for energy instead => making ketones as a byproduct

Question 9

How can you detect ketones?

Answer 9

Breath via acetone => Kussmaul breathing
Urine via acetoacetate but is a delayed reading of ketone levels in the body
Blood via ketone meters which is the same as the glucometer

Question 10

What conditions may increase your ketone levels without being a type 1 diabetic? In terms of an emergency station, why’re these more reassuring?

Answer 10

Gastroenteritis, pancreatitis, starvation, alcohol
These are more reassuring as none of these present with hyperglycemia as well => giving IV dextrose bolus will often clear the ketones

Question 11

In an emergency station, when do you give insulin? What should be given with insulin always in a case of diabetic ketoacidosis?

Answer 11

Insulin should be given 1 hour later with maintenance fluids that is reinforced with K+ potassium to avoid hypokalemia (arrythmias) and deficiencies of Mg and Phosphate like in refeeding syndrome

Question 12

When should parents contact healthcare services in terms of ketone levels?

Answer 12

When there is >1mmol/L

Question 13

This is an emergency station with a Type 1 diabetic with ketoacidosis. Run through it quick ABC and any additional things to do for this case

Answer 13

A - Usually patent
B - Kussmaul breathing => rebreather mask
C - HR (tachycardic), CRT (>2s) => Give bolus (10-20ml/kg) 0.9% NaCl and check again!! follow with bolus or maintenance fluids based on result
Give Insulin 1 hour later with maintenance fluids that is reinforced with K+
D - Monitor glucose levels after giving insulin. If low, add dextrose and correct over 48 hours

Question 14

During an emergency station, you notice the patient has Kussmaul breathing. When receiving blood gas results, what do you expect to see?

Answer 14

Low CO2 levels because the lungs are working overtime to reduce the acid which in reality here is metabolic acidosis as the ketones are causing the acidity not the CO2.

Question 15

What is the risk of giving too much fluids during resus of a patient with diabetic ketoacidosis?

Answer 15

Cerebral oedema, arrhythmias, subarachnoid hemorrhage (burst from fluid). These are the causes of mortality in DKA

Question 16

Cerebral oedema is one of the greatest causes of mortality from DKA. What are the RFs for cerebral oedema in DKA? (4)

Answer 16

Less CO2 (from kusmmaul breathing)
Severe dehydration
younger
new diagnosis of T1DM