Diabetic Ketoacidosis In Children

What is diabetic ketoacidosis?

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.

What increases my child's risk for diabetic ketoacidosis?

Diabetes that is not controlled is the main risk factor. The following may also increase the risk:

  • Your child is not taking his insulin or is not getting the right amount.

  • Your child has an illness, infection, accident, or surgery. Any condition that stresses your child's body may lead to DKA.

  • Your child is having her monthly period. This may change how her body reacts to glucose.

  • Your child is taking certain medicines. Ask if any of your child's medicines can lead to DKA.

What are the signs and symptoms of diabetic ketoacidosis?

Your child may feel very thirsty, and urinate more than usual. He may have a fever. He may also have any of the following:

  • Dry mouth, eyes, and skin

  • Fast, deep breathing

  • Faster heartbeat than normal for him

  • Abdominal pain, nausea, and vomiting

  • Fruity, sweet breath

  • Mood changes and irritability

  • Feeling very weak, tired, and confused

  • Weight loss

How is diabetic ketoacidosis diagnosed?

Your child's caregiver will ask about your child's symptoms and when they started. He will ask how your child's diabetes is managed. He will look for signs of dehydration and check your child's height and weight. Caregivers may order other tests to find out what triggered your child's DKA. His blood and urine may be tested to check his blood sugar, ketone, and acid levels. The tests will also show if he is dehydrated.

How is diabetic ketoacidosis treated?

DKA can be life-threatening. Your child must get immediate treatment. The goal of treatment is to replace lost body fluids, and to bring blood sugar levels back to normal. Treatment also works to decrease the amount of ketones and acid in your child's body.

  • IV fluids: Fluids are given to treat dehydration. Electrolytes (body salts) may be added to the fluids to replace what has been lost from his body.

  • 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 work to decrease the acid level in his body.

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

What can I do to prevent my child from developing diabetic ketoacidosis?

The best way to prevent DKA is to help your child control his diabetes. Ask your child's caregiver for more information on how to manage your child's diabetes. The following may help decrease your child's risk for DKA:

  • Check your child's blood sugar levels: Follow your child's caregiver's instructions about when to test your child's blood sugar levels. You may need to check at least 3 times each day. If his blood sugar level is too high, give him insulin as directed by his caregiver. The caregiver can show you how to use a blood glucose monitor to check your child's level.



  • Check your child's ketones: Follow your child's caregiver's instructions about when you should check your child's blood or urine for ketones. You may be given a machine to check your child's blood ketones. Urine ketones can be checked with sticks you dip in your child's urine. Do not allow your child to exercise if he has ketones in his urine or blood.



  • Know how to manage sick days: When your child is sick, he may not eat as much as he normally does. You may need to change the amount of insulin he gets. You will need to check his blood sugar level more often. You may also need to check for ketones. Make a plan with your child's caregiver about how to manage your child's diabetes when he is sick.

  • Know how to treat DKA: If your child has signs of DKA, give him more liquids that do not contain sugar. Give your child insulin as directed by his caregiver.

  • Call your child's diabetes team as often as needed: Ask your child's caregiver about a diabetes team. Call the team if your child's blood sugar level is high, or he has ketones in his blood or urine. The team is available for any questions or concerns you have about your child's diabetes.

What are the risks of diabetic ketoacidosis?

  • 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.

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • Your child's blood sugar level is lower or higher than you were told it should be.

  • Your child has a fever or chills.

  • Your child has ketones in his blood or urine.

  • Your child is more thirsty than usual.

  • Your child is urinating more often than he usually does.

  • You have questions or concerns about your child's condition or care.

When should I seek immediate care for my child?

Seek care immediately or call 911 if:

  • Your child has fruity, sweet breath.

  • Your child has severe, new stomach pain, and is vomiting.

  • Your child is more drowsy than usual.

  • Your child begins to breathe fast, or is short of breath.

  • Your child becomes weak and confused.

  • Your child has a seizure, or becomes unconscious.

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. 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.

© 2013 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.

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