Diabetic ketoacidosis in paediatrics: tools to assist in recognition of a sick child

2021 ◽  
Vol 13 (7) ◽  
pp. 275-279
Author(s):  
Grace Marrion
Keyword(s):  
Diabetic Ketoacidosis ◽  
Viral Infections ◽  
Early Recognition ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Childhood Mortality ◽  
Medical Emergency ◽  
Childhood Diabetes

Diabetic ketoacidosis (DKA), a complication of diabetes, is a medical emergency in children and is one of the main causes of childhood mortality. It is the first presentation of diabetes in 30–40% children with the condition, and is more common in younger children. However, it is commonly misdiagnosed as the signs and symptoms in children vary. Treatment should be given as soon as possible, and this is usually only possible in a hospital setting. Therefore, early recognition and transportation to hospital by paramedics ensures the best possible outcome. Children are far more likely to have type 1 than type 2 diabetes, and several factors are associated with childhood diabetes, including genetics, medication, viral infections and environmental issues. Several tools and guidelines can be used to assess children prehospitally. These should be used in conjunction with the clinician's knowledge and standard observations. Paramedics should take an appropriate history, as this could prove invaluable for hospital specialists.

Diabetic ketoacidosis in childhood and adolescence

2011 ◽  
pp. 1888-1894 ◽  
Author(s):  
M. Silink
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hispanic Americans ◽  
Viral Infections ◽  
Childhood And Adolescence ◽  
Oral Hypoglycaemic Agents ◽  
Obesity Epidemic

Diabetic ketoacidosis (DKA) may occur at the time of diagnosis of diabetes, or at any time subsequently. It is the cause of very significant morbidity and remains the most common cause of death in childhood and adolescent diabetes (1–3). For a discussion of DKA in adults, see Chapter 13.4.10.1. Type 1 diabetes occurs in childhood (see Chapter 13.4.7) with an incidence that varies from more than 40 per year per 1 00 000 children under the age of 15 years old (in Finland), to less than 1 per 1 00 000 (in Asia). The mean age at diagnosis is usually 10–12 years old, although, in a number of countries, this seems to be declining. The younger the child is at diagnosis, the more aggressive the autoimmune-mediated destruction of the pancreatic β‎ cell, and the more rapid the progression to complete insulin dependence (see Chapter 13.2.3). Children are thus more liable to DKA than adults. Furthermore, children experience more viral infections than do adults, and the metabolic stresses associated with these infections increase their risk of developing DKA. DKA has traditionally been considered to occur only in type 1 diabetes, but is now being reported in at least 25% of (usually obese) adolescents with newly diagnosed type 2 diabetes, especially when there are associated stress factors, such as infection (4, 5). Although the vast majority of diabetes in childhood and adolescence is type 1 diabetes, there has been a worldwide trend to the earlier development of type 2 diabetes in association with the overweight and obesity epidemic, especially in certain at-risk ethnic groups, e.g. Asians, African Americans, Hispanic Americans; see Chapter 13.4.3.1. The treatment of DKA in these patients is the same as for those with type 1 diabetes; however, the subsequent course of the treatment usually differs, and most patients are able to stop insulin and be treated with oral hypoglycaemic agents, weight reduction, exercise, and an appropriate food plan.

scholarly journals Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic

2021 ◽  
Author(s):  
Elizabeth A C Sellers ◽  
Danièle Pacaud
Keyword(s):  
Type 1 Diabetes ◽  
Chronic Illness ◽  
Diabetic Ketoacidosis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Initial Diagnosis ◽  
Morbidity And Mortality ◽  
Time Period

Abstract Type 1 diabetes is a common chronic illness in childhood. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes. Early recognition of symptoms of diabetes and immediate initiation of treatment are important factors in preventing DKA at first presentation. We describe the numbers of children presenting with DKA at initial diagnosis across eight Canadian paediatric centres during the COVID-19 pandemic (March 15, 2020 to July 31, 2020) and compare this to the same time period in 2019. Comparing the pre-COVID to the COVID-19 time period, presentation in DKA increased from 36.4% to 55.0% (P<0.0001) and presentation in severe DKA from 37.0% to 48.3% (P=0.044). These findings are concerning and emphasize the importance of awareness of the signs and symptoms of diabetes. In addition, these findings raise concern about access to appropriate and timely care during the COVID-19 pandemic.

Causes of diabetic ketoacidosis: type 1 diabetes versus type 2 diabetes

2017 ◽  
Author(s):  
Marwa Omri ◽  
Rayene Ben Mohamed ◽  
Imen Rezgani ◽  
Sana Mhidhi ◽  
Aroua Temessek ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis

An Approach to diabetic ketoacidosis in an emergency setting.

2020 ◽  
Vol 15 ◽  
Author(s):  
Dario Pitocco ◽  
Mauro Di Leo ◽  
Linda Tartaglione ◽  
Emanuele Gaetano Rizzo ◽  
Salvatore Caputo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Blood Glucose Concentration ◽  
Diabetic Complication ◽  
Emergency Setting ◽  
Online Activity

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon. Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter regulatory hormones. Results: Goals of therapy are to correct dehydration, acidosis and to reverse ketosis, gradually restoring blood glucose concentration to near normal. Conclusion: Furthermore it is essential to monitor potential complications of DKA and if necessary, to treat them and any precipitating events.

Abstract 281: Cerebral Regional Oxygen Saturation (rSO 2 ) is Useful as a Physiological Monitoring Tool During CPR in the Pre-Hospital Settings. An Analysis of 87 Cases in Osaka, Japan

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Shinji Shigematsu ◽  
Tomohiko Sakai ◽  
Tadahiko Shiozaki ◽  
Mitsuo Ohnishi ◽  
Ryosuke Takegawa ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Primary Outcome ◽  
Hospital Setting ◽  
Primary Outcome Measure ◽  
Monitoring Tool ◽  
Non Invasive ◽  
Invasive Method ◽  
Neurologically Intact

Introduction: The simplified monitoring of regional cerebral oxygen saturation (rSO 2 ) is a non-invasive method of measuring cerebral perfusion, but continuous changes in the cerebral rSO 2 values among OHCA patients in the pre-hospital settings have not been sufficiently investigated. Our objective is to investigate the association between the change in rSO 2 pattern and patient outcome. Methods: We recently developed a very small portable rSO 2 monitoring system that can be used in the pre-hospital setting. The system can monitor cerebral rSO 2 immediately after attachment; monitoring is performed continuously during CPR. The system was used from June 2013 to May 2019 in Osaka City, Japan.The primary outcome measure was neurologically intact survival at 1 month. Results: We collected the continuous changes in the cerebral rSO 2 values of 87 OHCA patients during CPR by EMS personnel. The analyses of the continuous changes in the rSO 2 values of the 79 cases in which the rSO 2 value was measured before ROSC revealed two patterns of changes in the cerebral rSO 2 values. In type 1 (increasing rSO 2 type; n=38), the measured rSO 2 gradually increased during CPR or after ROSC. There were 3 patients of neurologically intact survival in type 1. In type 2 (non-increasing rSO 2 type; n=41), the measured rSO 2 did not increase during CPR. There was no patient of neurologically intact survival in type 2. We found an instructive phenomenon in the changes of the cerebral rSO 2 values. Measured rSO 2 dropped after confirmation of ROSC, which suggests that re-arrest had occurred during monitoring. Conclusion: We measured the continuous changes in cerebral rSO 2 values among 87 patients with OHCA in the pre-hospital setting and found 2 patterns and an instructive phenomenon in the continuous changes in rSO 2 values. Increasing type rSO 2 during CPR appeared to be associated with neurologically intact survival at 1 month.

Development and Implementation of a Diabetic Ketoacidosis Protocol for Adults With Type 1 and Type 2 Diabetes at a Tertiary Care Multicampus Hospital

2019 ◽  
Vol 43 (4) ◽  
pp. 256-260.e3 ◽  
Author(s):  
Medina Mohamed ◽  
Angela Assal ◽  
Loree Boyle ◽  
Edmund Kwok ◽  
Filomena DeSousa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care

FAMILY HISTORY OF DIABETES IS ASSOCIATED WITH INCREASED RISK OF RECURRENT DIABETIC KETOACIDOSIS IN PEDIATRIC PATIENTS

2020 ◽  
Vol 26 (3) ◽  
pp. 305-311
Author(s):  
Janaki D. Vakharia ◽  
Sungeeta Agrawal ◽  
Janine Molino ◽  
Lisa Swartz Topor
Keyword(s):  
Diabetes Mellitus ◽  
Family History ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Incidence Rate Ratio ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus

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