Pediatric DKA Flashcards
DKA definition
hyperglycemia over 200 mg/DL AND
acidotic: venous ph less than 7.3 and or bicarb under 15 mmol/L
mild dka
ph less than 7.3, bicarb under 15 mmol/L
moderate dka
ph less than 7.2, bicarb less than 10
severe dka
ph less than 7.1 bicarb less than 5
if suspect dka what 2 quick labs do you want to check?
blood sugar and UA (look for glucose and large ketones)
underlying pathophys problem causing DKA
pancreas not making enough insulin - seen mostly with type 1 DM
liver thinks cells are staring so starts to create more glucose
breaks down proteins and fats making ketoacids = acidosis and then ..
dehydration and poor perfusion leads to lactic acidosis = 2 kinds of acidosis
what 2 kinds of acidosis occur with DKA
lactic acidosis (dehydration / poor perfusion) metabolic ketoacidosis (ketoacid production)
hyperglycemia sx
polyuria, polydipsia, weight loss, muscle cramps, incontinence
acidosis sx
abdominal pain, vomiting, SOB, HA, confusion, AMS
kussmaul respirations are..
deep sighing respirations - trying to decrease CO2 in blood to regulate the acidosis back to normal
besides kussmaul respirations will see..
dehydration (sunken eyes, dry mucous membranes)
tachycardia
delayed cap refill
abdominal tenderness (nonfocal or epigastric)
who is at highest risk for DKA?
kids under 5
DKA is most common cause of…
diabetic death in childhood
why do kids with DKA get dehydrated?
osmotic diuresis and vomiting
why do kids with DKA have electrolyte imbalance?
ketoacids bind NA and K which gets excreted then in urine
this leads to hyponatremia and hypokalemia
what are the four Is of DKA precipitants
insulin lack
indiscretion (dietary)
infection
impregnation (or other stressors)
how often check a DKA pts.. accucheck? VBG BMP neurological check?
accuchekc and neurological check every hour
VBG every 1-2 hours
BMP every 4 hours
consult endocrinology and critical care
first step of DKA treatment
IV hydration: NS bolus or LR bolus
20 ml/kg over 1 hour
then do LR at 2 times the maintaince ivf rate
concern with correcting dehydration too quickly
cell swelling and cerebral edema
step 2:
insulin IVF bolus
.05-.1 U/kg/hr regular insulin
**for kids no insulin bolus - cerebral edema
ideally don’t want glucose levels to drop more than __ per hour
100mg/dl
when glucose is finally under 300mg/dL what should you switch do?
D5NS
step 3… reverse the acidosis .. how?
insulin administration - stops ketoacid production
IV hydration - reverses lactic acidosis
after 4-6 hours of the normal saline at 2X the maintainence rate switch to…
.45% saline with electrolytes
