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Diabetic Ketoacidosis: BSPED Guidelines: DR Akshat Juneja

The document outlines guidelines for diagnosing and managing Diabetic Ketoacidosis (DKA) in pediatric patients, emphasizing the importance of blood ketone levels for diagnosis and monitoring. It details the clinical features, severity classification, and emergency response strategies, including fluid and potassium management, insulin therapy, and the assessment for cerebral edema. The document also addresses hyperosmolar hyperglycemic state and provides recommendations for treatment protocols in emergency settings.

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medpie18
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22 views33 pages

Diabetic Ketoacidosis: BSPED Guidelines: DR Akshat Juneja

The document outlines guidelines for diagnosing and managing Diabetic Ketoacidosis (DKA) in pediatric patients, emphasizing the importance of blood ketone levels for diagnosis and monitoring. It details the clinical features, severity classification, and emergency response strategies, including fluid and potassium management, insulin therapy, and the assessment for cerebral edema. The document also addresses hyperosmolar hyperglycemic state and provides recommendations for treatment protocols in emergency settings.

Uploaded by

medpie18
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Diabetic Ketoacidosis : BSPED

Guidelines

Dr Akshat Juneja

Department of Pediatrics
Diagnosis
Acidosis:

• Blood pH below 7.3 OR


• Plasma bicarbonate below 15 mmol/litre.

Ketonaemia: Blood beta-hydroxybutyrate above 3 mmol/litre.


Blood Glucose: Typically elevated (>200 mg/dl).

Note: DKA can occur with normal blood glucose in children/young


people with known diabetes.
Severity - Classification
Monitoring

Blood ketone (beta-hydroxybutyrate) levels highly recommended for


diagnosis & monitoring.

Urinary ketones: Can be used for initial diagnosis if near-patient testing


unavailable, but NOT reliable for monitoring treatment progress.

"Ketones++" on dipsticks typically >3.0 mmol/l blood ketones.


Clinical Features

Typically exhibit clinical dehydration with :

• Acidotic respiration (Kussmaul breathing).

• Drowsiness.

• Abdominal pain, nausea, vomiting


Hyperosmolar Hyperglycaemic State

• Hyperosmolarity.

• Very high blood glucose (>600 mg/dl).

• Little or no acidosis or ketones.

• Occurrence: More common in type 2 diabetes, but can occur in type 1.


ER Approach
ER Approach
ER Approach
ER Approach
• Shock Definition (APLS criteria): Tachycardia, prolonged central capillary refill,
poor peripheral pulses, hypotension (late sign).

• Acidosis can cause peripheral vasoconstriction (may mimic poor perfusion).

• NICE emphasizes weak thready peripheral pulses & hypotension as indicators.

• Raised WBC common in DKA, doesn't inherently indicate sepsis.

• Suspect Sepsis if: Fever or hypothermia, hypotension, refractory acidosis, or lactic


acidosis.
Assessment for ?Cerebral Edema
Assessment for ?Cerebral Edema
Detailed
Management
Detailed
Management
Detailed
Management
Fluid Deficit Calculation
Effect of Boluses?
Maintenance Fluid Calculation
Fluid Calculation Formula
Potassium Management
Potassium Management
• Total body potassium invariably depleted, even if initial plasma levels appear
normal/high. Exacerbated by insulin therapy (drives K+ intracellularly).

• Supplementation: All IV fluids (except initial boluses) must contain 40 mmol/l


potassium chloride.

• If High K+ at Presentation: Only add potassium after patient has passed urine
(confirms renal function)

• Defer insulin initiation until potassium > 3.0 mmol/l.

• >40meq/l requirement : Central Line / +oral (if delayed)


Insulin Therapy
Insulin Therapy
IV to SC transition
Bicarbonate
Sodium
Anion Gap
Observations
Cerebral Edema
Mannitol

Mannitol Effect & Repeat Dosing:

Effect typically apparent within 15 minutes, lasts ~120 minutes.

If no improvement within 30 minutes, repeat dose or prefer hypertonic saline.

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