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Diabetes Mellitus, Juvenile, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Decrease in effective circulating insulin

  • Increase in counter regulatory hormones including glucagon, catecholamines, cortisol, and growth hormone

  • Hyperglycemia owing to:

    • Decreased peri...

Diagnosis

Signs and Symptoms

  • Polydipsia

  • Polyuria (may have good urine output despite dehydration)

  • Nocturia

  • Polyphagia

  • Malaise, weight loss

  • DKA:

    • Initial presentation in 20–40% of patients

    • Often associated with...

Treatment

Pre-Hospital

For DKA: 
  • ABCs

  • Airway protection

  • Establish IV access and initiate fluid therapy.

Initial Stabilization/Therapy

For DKA: 
  • Oxygen

  • Cardiac monitor

  • IV access and volume resuscitation

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

For DKA: 
  • ICU:

    • Altered mental status

    • Shock or cardiac dysrhythmia

    • Initial glucose >700 mg/dL

    • Initial pH <7

    • Risk factors for cerebral edema (age <5 yr, prolong...

Pearls and Pitfalls

  • Mortality from DKA is predominately related to the occurrence of cerebral edema. Therefore, early and appropriate treatment is of most importance in managing children with DKA.

  • In c...

Additional Reading

  • Al Hanshi  S, Shann  F. Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr Crit Care Med.  2011;12:137–14...

Codes

ICD9

  • 250.01 type I diabetes mellitus [insulin dependent type] [IDDM] [juvenile type], not stated as uncontrolled, without mention of complication

  • 250.03 Diabetes mellitus without mention of compli...

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