Diabetic Ketoacidosis (DKA)
Pre-reading
Emergency Medicine Cases Podcast : Paediatric DKA
| Diabetic Ketoacidosis Guideline |
Workbook Questions
Diabetic Ketoacidosis
Case 1
A 20kg, 6-year-old girl presents to the Emergency department with a 2-day history of lethargy and abdominal pain. She had 3 vomits this morning and is unable to keep anything down. On further questioning you discover she has had increased thirst and bed wetting, which is new over the last 2 weeks. The nurse at triage does a BSL and it reads high.
You decide to place an IV line and take a venous gas, the results are below:
Her observations are as follows : HR 130, RR 42, Sats 99% RA, Temp 36.4, CRT < 2 secs
Diabetic Ketoacidosis
Case 1
A 20kg, 6-year-old girl presents to the Emergency department with a 2-day history of lethargy and abdominal pain. She had 3 vomits this morning and is unable to keep anything down. On further questioning you discover she has had increased thirst and bed wetting, which is new over the last 2 weeks. The nurse at triage does a BSL and it reads high.
- What do you expect this girl will look like in the bed and what are the likely abnormalities in her observations?
You decide to place an IV line and take a venous gas, the results are below:
- pH 7.15
- pO2 100
- pCO2 26
- HCO3 18
- Na+ 132
- K+ 5.0
- BSL 36 mmol/L
- Ketones 6.2
- Can you interpret the gas above?
Her observations are as follows : HR 130, RR 42, Sats 99% RA, Temp 36.4, CRT < 2 secs
- What are your immediate management priorities?
- You decide not to give a fluid bolus but estimate 5% dehydration, using the table below calculate her fluid replacement
- An hour after starting the Iv fluids her BSL is 32 and Ketones are 6.1, what is the next step in your management? How would you prescribe this?
- You continue to check hourly blood gases and ketones and 2 hours later the BSL is 11 and the Ketones are 3.6, how would your change your existing management?
- What are the complications of DKA and the treatment of DKA to look out for?