Management of diabetic ketoacidosis in children

Question 1

Clinical signs of DKA in children

Answer 1

• N&V
• Anorexia
• Dehydration
• Kussmaul’s breathing
• Acetone breath
• Abdominal pain
• Confusion
• Drowsiness -> Coma

Question 2

Diagnostic criteria for DKA in children

Answer 2

• pH <7.3 or HCO3 <15mmol/L
• Ketones >3mmol/L
• +/- Blood glucose >11mmol/L

Question 3

Aims of DKA management in children

Answer 3

1. Restore circulating volume
2. Switch of ketogenesis and make glucose available intracellularly
3. Closely monitor for complications
4. Investigate and treat the underlying cause

Question 4

Suggested fluid management for DKA in children

Answer 4

• 10ml/kg boluses reassessing shock status in between each bolus up to 40ml/kg
• Consider vasopressors after this
• Commence maintenance fluids with 40mmol KCl in them

Question 5

Calculating fluid requirements in DKA

Answer 5

Requirement= (deficit- resuscitation) + maintenance

Question 6

Resolution of DKA in children

Answer 6

• pH >7.3
• serum bicarbonate >15 mmol/L
• ketones <1 mmol/L

Question 7

Complications of DKA in children or the treatment of DKA

Answer 7

• Hyperchloraemic metabolic acidosis
• Hypokalemia
• Hypoglycaemia
• Cerebral Oedema
• AKI
• VTE
• Aspiration pneumonia

Question 8

Management of cerebral oedema in paediatric patients with DKA

Answer 8

• A-E, help
• Hypertonic saline 3% 3ml/kg or mannitol 0.5-1g/kg
• Half maintenance fluid rate
• Neuroprotective measures
• Intubation
• CT head