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Diabetic Ketoacidosis In Children

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your child's blood sugar levels become high because his body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used 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 DKA?

  • Not enough insulin

  • Poorly controlled diabetes

  • Infection or other illness

  • Heart attack, stroke, trauma, or surgery

  • Emotional stress

  • Being female

What are the signs and symptoms of DKA?

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 DKA diagnosed?

Your child's healthcare provider will ask about your child's symptoms and how his diabetes is managed. He will look for signs of dehydration and check your child's height and weight. Your child's blood and urine may be tested to check his blood sugar and ketone levels. These and other tests will show if your child is dehydrated. He may also need an EKG to check his heart rhythm. Your child may need more tests to find out what triggered his DKA.

How is DKA treated?

DKA can be life-threatening. Your child must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring blood sugar levels back to normal. Your child may need any of the following:

  • IV liquids help treat dehydration. Electrolytes may be added to the fluids to replace what has been lost from your child's body.

  • Insulin decreases the amount of sugar in your child's blood. He may need to take insulin until his blood sugar level becomes normal.

  • Glucose may be needed if 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.

How can I help prevent DKA?

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

  • Monitor your child's blood sugar levels closely if he has an infection, is stressed, or experiences trauma. Check his blood sugar levels often. You may need to check at least 3 times each day. If your child's blood sugar level is too high, give him insulin as directed by his healthcare provider. The healthcare provider can show you how to use a blood glucose monitor to check your child's levels.



  • Manage your child's 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 than usual. Make a plan with your child's healthcare provider about how to manage your child's diabetes when he is sick.

  • Check your child's ketones as directed. Follow your child's healthcare provider'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 treat DKA symptoms at home. If your child has signs of DKA, give him more liquids that do not contain sugar, such as water. Give your child insulin as directed by his healthcare provider and go to the nearest emergency room.

Call 911 for any of the following:

  • Your child has a seizure or becomes unconscious.

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

  • Your child becomes weak and confused.

When should I seek immediate care?

  • Your child has fruity, sweet breath.

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

  • Your child is more drowsy than usual.

When should I contact my child's healthcare provider?

  • 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.

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.

© 2015 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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