Diabetic Ketoacidosis In Children

WHAT YOU SHOULD KNOW:

Diabetic ketoacidosis (DKA) is a life-threatening condition that happens when diabetes is not controlled. Your child's blood sugar levels become dangerously high because his body does not have enough insulin. Insulin is a hormone that helps your child's body take sugar out of his blood and use it for energy. The lack of insulin forces his body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in the blood. Ketones are dangerous at high levels.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • DKA increases your child's risk for severe dehydration. The loss of body salts may cause life-threatening abnormal heartbeats. Blood flow to his organs may be decreased and cause organ failure. Decreased blood flow to his brain may lead to swelling, seizures, coma, and death.

  • Treatment may cause your child's blood sugar level to become too low. Very low blood sugar levels may cause seizures, or he may become unconscious. IV fluid replacement may cause trouble breathing from fluid buildup. Fluids may also cause cerebral edema (water around the brain), which can be life-threatening.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

An IV

is a small tube placed in your child's vein that is used to give him medicine or liquids.

Monitoring:

  • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

  • Daily weight: Your child may be weighed each day. Healthcare providers compare your child's weight from day to day. This helps healthcare providers see how much body fluid your child has. If he loses too much body fluid, he can become dehydrated. If he has too much body fluid, he may have trouble breathing.

  • Intake and output: Your child's healthcare provider may need to know how much liquid your child is getting and urinating. Your child may need to urinate into a container in bed, or in the toilet. A healthcare provider will then measure the amount your child urinated. If your child wears diapers, save them so a healthcare provider can weigh them. Do not throw diapers away or flush urine down the toilet before asking your child's healthcare provider.

  • Neurologic signs: These are also called neuro signs, neuro checks, or neuro status. During a neuro check, caregivers see how your child's pupils react to light. They may check his memory and how easily he wakes up. His hand grasp and balance may also be tested. How your child responds to the neuro checks can tell caregivers if his illness or injury has affected his brain.

Tests:

  • Blood glucose tests: Healthcare providers may need to check your child's blood sugar level at least 3 times each day. This is usually done before meals and at bedtime. His blood is tested in a glucose monitor.

  • Blood tests: Your child's blood is tested for ketones, sugar, and electrolyte levels. He may need to have blood drawn more than once.

  • Blood gases: This test is also called an arterial blood gas, or ABG test. Your child's blood is tested for the amount of acid it contains, and gases such as oxygen and carbon dioxide.

  • Urine sample: A sample of your child's urine is tested for the amount of ketones and sugar it contains.

  • Cultures: Cultures may be done if your child has an infection. This test may help healthcare providers learn what germ is causing his illness. Cultures can be done with blood or urine.

  • 12 Lead EKG: This test helps caregivers see your child's heart activity. It helps caregivers look for changes or problems in different areas of the heart. Sticky pads are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine or TV-like screen. This machine shows a tracing of your child's heartbeat. This test takes about five to ten minutes. Your child must lie very still during the test.

Treatment:

The goal of treatment is to replace lost body fluids, and bring blood sugar levels back to normal. Treatment also decreases the amount of ketones and acid in your child's body.

  • IV fluids: Fluids are given through an IV to treat your child's dehydration. Electrolytes (body salts) may be added to the fluids to replace what has been lost from your child's body. The most common body salt that needs to be replaced is potassium.

  • Medicines:

    • Insulin: Insulin decreases the amount of sugar in your child's blood. He may need to take insulin until his blood sugar level becomes normal. The insulin will also decrease the acid level in your child's body.

    • Glucose: Glucose may be given when your child's blood sugar level begins to decrease. This is to prevent low blood sugar while he is getting insulin.

    • Antibiotics: Antibiotics may be given if an infection has led to your child's DKA. Antibiotics will help your child fight an infection caused by bacteria.

If your child is unconscious:

  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. An arterial line may be used to measure your child's blood pressure or to take blood.

  • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your child's neck, groin, or near his collarbone. The CVP line may be used to give medicines, draw blood, or to check your child's heart.

  • Heart monitor: This is also called telemetry. Up to 5 sticky pads are placed on your child's chest. Each pad has a wire leading to a monitor or to a small portable box (telemetry unit). An ongoing picture of your child's heartbeat is shown. Healthcare providers watch this picture to make sure your child's heart is working normally.

  • Your child may need extra oxygen if his blood oxygen level is lower than it should be. Your child may get oxygen through a mask placed over his nose and mouth or through small tubes placed in his nostrils. Ask your child's healthcare provider before you take off the mask or oxygen tubing.

  • ET tube: Your child may need an endotracheal (ET) tube to help him breathe. An ET tube is put in your child's mouth or nose, and goes into the trachea (windpipe). It may be connected to a breathing machine called a ventilator. The ET tube will be taken out when your child is breathing better.

  • Foley catheter: This is a tube put into your child's bladder to drain his urine into a bag.

  • Nasogastric tube: This is also called an NG tube. An NG tube is put down your child's nose and into his stomach. The tube is attached to a suction machine that pulls fluids out of your child's stomach. This helps keep your child from getting stomach fluids into his lungs.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Diabetic Ketoacidosis In Children (Inpatient Care)

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