Diabetic ketoacidosis

Emergency assessment

Confirm the diagnosis

• Characteristic history
  • polydipsia, polyuria
• Biochemical confirmation
  • glycosuria
  • ketonuria
  • BG
  • pH
• Clinical assessment
  • full examination paying special attention to

• Severity of dehydration
  • 3% just detectable
  • 5% dry mucous membranes, , reduced skin turgor
  • 10% capillary return 3 seconds or more, sunken eyes
  • 10%+ shock, poor peripheral pulses

• Evidence of acidosis
  • hyperventilation
• Assessment of conscious level (and examine pupils and retinal fundi)

Optimal management of children with severe DKA (pH <7.1, hyperventilation, in shock, depressed level of consciousness, persistent vomiting, age <5 years) is in an intensive care unit or at least in a children’s ward specializing in diabetes care

Immediate investigation

• Weigh child whenever possible (or obtain recordings from recent visits)
• Capillary BG (often inaccurate in the presence of poor peripheral circulation and severe acidosis)
• Venous BG, electrolytes and urea
• Capillary, venous or arterial blood gases
• As indicated: full blood count (leukocytosis is a common feature of DKA), HbA_1c , urine culture, throat swab, chest x-ray, blood cultures. Height measurement or estimation is of value if calculation of body surface area is required