What is diabetic ketoacidosis in child?
Diabetic ketoacidosis (DKA) in children is defined as a blood glucose level over 11 mmol/L, venous pH below 7.3 or serum bicarbonate level below 15 mmol/L, and either the presence of ketonemia (blood β-hydroxybutyrate level ≥ 3 mmol/L) or moderate to high ketonuria.
What are the differential diagnosis of DKA?
In considering a diagnosis of diabetic ketoacidosis (DKA), the following indications should be taken into account: uremia, acute hypoglycemia coma, and catheter-related venous thrombosis, especially with femoral central venous catheters in children.
What lab values indicate DKA?
Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor.
What triggers DKA in children?
Diabetic ketoacidosis (DKA) is considered to be a common presentation of both type 1 diabetes mellitus and type 2 diabetes mellitus in children and adolescents. DKA arises due to lack of adequate insulin in the body. Insulin stops the use of fat as an energy source by inhibiting the peptide hormone glucagon.
Which electrolyte is most affected in diabetic ketoacidosis?
Loss of Potassium During Episode of DKA First entity to get disturbed by the lack of insulin is electrolytes among which, potassium is most affected (6, 7).
What is starvation ketoacidosis?
Starvation ketoacidosis (SKA) represents one of three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. While easily treated, it is a diagnosis that can be easily missed in patients with an unexplained metabolic acidosis.
What labs are abnormal in DKA?
Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include blood pH < 7.3, serum bicarbonate < 18 mEq/L, anion gap > 10 mEq/L and increased serum osmolarity.
How common is DKA in children?
Frequencies range from 15% to 70% in Europe and North America. DKA at diagnosis is more common in children aged under 5 years, and in children whose families do not have ready access to medical care for social or economic reasons. The risk of DKA in established type 1 diabetes is 1-10% per per year.
How to diagnose diabetic ketoacidosis ( DKA ) in children?
In considering a diagnosis of diabetic ketoacidosis (DKA), the following indications should be taken into account: uremia, acute hypoglycemia coma, and catheter-related venous thrombosis, especially with femoral central venous catheters in children. Differential Diagnoses. Glaser NS, Marcin JP, Wootton-Gorges SL, et al.
How much insulin should be given to a child with DKA?
Children with DKA should generally be commenced at 0.1 units/kg/hour Children with BGL <15 mmol/L at the time of commencement of the insulin infusion Insulin infusion can be run as a sideline with the rehydration fluids via a three-way tap provided a syringe pump is used. Ensure the insulin is clearly labelled
What should my blood sugar be if I have DKA?
Insulin should either be clear or evenly cloudy with small flecks. If you’re on an insulin pump, look closely for insulin leaks, and check your tube connections for air bubbles. Talk to your doctor if your blood sugar levels are often out of your target range.
What are the biochemical criteria for diabetic ketoacidosis?
Children with DKA are deplete in total body potassium regardless of the initial serum potassium level. Measured serum sodium may be low due to osmotic dilution with glucose. Corrected sodium levels should be calculated and monitored. The biochemical criteria for diagnosis of DKA are: Venous pH <7.3 or Bicarbonate <15mmol/L
How often does DKA occur in Type 1 diabetics?
Rates of DKA in youth with type 1 diabetes vary widely nationally and internationally, from 15% to 70% at diagnosis ( 4) to 1% to 15% per established patient per year ( 9 – 11 ). However, data from systematic comparisons between countries are limited.
What are the rates of DKA in Germany?
In Germany, pediatric patients with diabetes with DKA had diabetes-related costs that were up to 3.6-fold higher compared with those without DKA ( 8 ). Rates of DKA in youth with type 1 diabetes vary widely nationally and internationally, from 15% to 70% at diagnosis ( 4) to 1% to 15% per established patient per year ( 9 – 11 ).
When does a DKA occur after Aha therapy?
The primary outcome of this study was the first DKA event that occurred after the index date of an AHA therapy, identified from a diagnosis code recorded in inpatient or emergency room claims. To be considered an incident event, DKA occurring after exposure to a new AHA had to occur ≥30 days after any pre-index DKA event.
How is DKA information obtained in the UK?
Information about DKA admissions was obtained by linkage of unique patient identifiers submitted to the NPDA with the Hospital Episode Statistics (England) and the Patient Episode Database for Wales (Wales). These two databases collect information on all hospital admissions in England and Wales, with ICD classification being used to code the data.