Paed Hyperglycaemia And Ketosis

Question 1

What defines mild-moderate hyperglycaemia / ketosis?

Answer 1

BGL ≥ 11 OR ketones ≥ 0.6 mmol/L

AND

Does not meet criteria for severe hyperglycaemia

May have evidence of mild diabetes-related illness (e.g. mild lethargy, dry mouth / thirst, polydipsia, polyuria)

Question 2

What is the Mx for mild to moderate hyperglycaemia / ketosis?

Answer 2

• Exclude other causes that may require emergency department care, e.g. acute coronary syndrome, infection / sepsis.
• VED referral.

Question 3

What indicates severe hyperglycaemia / ketosis?

Answer 3

1. BGL > 27.8 AND / OR ketones > 3 mmol/L
2. less than adequate perfusion
3. Clinical features DKA or HSS

Question 4

What is the treatment for paediatric patients with severe hyperglycaemia / ketosis?

Answer 4

1. Cardiac monitoring and ECG
2. Request MICA support for IV fluids
3. Transport

Question 5

Clinical features of DKA (7) and HSS (2)

Answer 5

Clinical features of DKA
- Dehydration
- Ketonic breath
- Kussmal respiration / Tachypnea
- Altered conscious state
- Nausea + vomiting
- Abdo pain
- Profound thirst

Clinical features of HHS:
- altered conscious state
- dehydration.

Question 6

Care objectives: hyperglycaemia and ketosis

Answer 6

1. Identification of high risk hyperglycaemia
2. Hydration where indicated