Pathophysiology: Insulin deficiency precipitated by stress, infection, or non-compliance leads to increase in counterregulatory hormones resulting in lipolysis, proteolysis, glycogenolysis, and decrease in glucose utilization. Leads to ketogenesis and hyperglycemia.
ONGOING LABS:
Treatment
References:
Agus MS, Wolfsdorf JI. Diabetic Ketoacidosis in Children. Pediatr Clin North Am 2005;52(4):1147-63, ix.
Glaser NS, et al. Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial. Pediatric Diabetes 2013; 14: 435–446.
INSULIN
** NEVER BOLUS WITH INSULIN **
Initial Labs and Assessment:
Symptoms:
FLUIDS
** Do not add potassium to IVF until patient has voided and serum K > 5.5 (patients are total body depleted of K, but acidosis causes extracellular shift of potassium, which can lead to arrhythmias) **
** NEVER BOLUS BICARBONATE (increased risk of cerebral edema and herniation) **