Diabetic Ketoacidosis
What is it?
Diabetic ketoacidosis is a medical emergency in which
high blood sugar and low insulin levels cause
life-threatening symptoms that can lead to coma.
Who gets it?
Diabetic ketoacidosis can occur in children who have
undiagnosed or poorly controlled diabetes mellitus (also
simply called diabetes).
What causes it?
Diabetes mellitus is a condition in which blood glucose
(sugar) is at abnormally high levels because the body is
unable to release or use insulin properly. High blood
sugar is called hyperglycemia. Insulin is a hormone that
converts glucose to glycogen, which lowers the blood
glucose level and is stored until the body needs the
glucose for energy. Diabetic ketoacidosis occurs when
blood sugar levels rise above normal. Because the body
doesn’t have the insulin it needs to move the glucose out
of the blood, the body starts to break down fat for
energy. The fat byproducts that result are called ketones,
which make the blood extremely acidic (acidosis). These
ketones, combined with the high blood sugar levels, create
a chemical imbalance called ketoacidosis. The most common
causes of diabetic ketoacidosis in children are
undiagnosed diabetes mellitus or failure to follow a
doctor’s recommended treatment for diabetes mellitus.
Other causes of diabetic ketoacidosis include
gastrointestinal upset, infection, injury, or illness.
What are the symptoms?
At first, diabetic ketoacidosis causes excessive thirst
and urination. Children usually complain of abdominal
pain, and may feel nauseated and vomit. Other symptoms
include flushed skin; rapid, deep breathing; confusion;
and restlessness. The child’s breath will have a fruity
smell, caused by the high levels of ketones. Without
treatment, the condition progresses to diabetic coma.
How is it diagnosed?
In children, ketoacidosis is often the first sign of
insulin-dependent diabetes mellitus. To diagnose diabetic
ketoacidosis, your doctor will take the child’s medical
history and perform a complete physical examination. He or
she will order blood tests to measure the levels of
glucose and other chemicals. Other tests may be ordered to
diagnose the cause of the child’s condition.
What is the treatment?
Diabetic ketoacidosis is treated with insulin and
fluids given through IVs (intravenously). The child’s
blood sugar and chemical levels are monitored to measure
the effectiveness of the treatment and make adjustments as
needed. Antibiotics are given if the condition is caused
by infection. If the condition is mild and caught early,
the child may be treated in the emergency room and then
released. However, extremely young patients and those with
severe vomiting require specialized treatment and
monitoring in a pediatric intensive care unit (PICU). If
the child is in a coma, he or she will have a nasogastric
tube inserted to prevent vomiting and aspiration
(inhalation of substances into the lungs). The child will
also have a catheter to drain urine from the bladder. With
blood sugar and chemical levels restored to normal,
recovery can occur anywhere within a few hours to days.
Once at home, your doctor will work with you to fine-tune
the child’s insulin requirements.
Self-care tips
You can prevent diabetic ketoacidosis in a child with
diagnosed diabetes mellitus by following the treatment
plan prescribed by your doctor. Make sure the child
doesn’t miss an insulin injection, follows a healthy diet,
and is physically active. Monitor his or her blood sugar
level regularly, and make sure you are aware of the
warning signs and symptoms of diabetic ketoacidosis.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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