Childhood emergencies

May 2010

FocusChildhood emergencies

Type 1 diabetes in children

Emergency management

Volume 39, No.5, May 2010 Pages 290-293

Aris Siafarikas

Susan O’Connell

Background

Fifteen to sixty-seven percent of patients with new onset type 1 diabetes mellitus (T1DM) present in diabetic ketoacidosis (DKA), of which approximately 79% initially see their general practitioner. Diabetic ketoacidosis is the most common cause of diabetes related deaths, mainly due to cerebral oedema that occurs in 0.4–3.1% of patients.

Objective/s

The aim of this review is to provide information to improve the early recognition of DKA and to provide guidelines for the initial management of DKA in the nonspecialist setting.

Discussion

Recognition of DKA can be improved by increasing the awareness for early clinical symptoms such as polyuria and polydipsia. It is important to include urinalysis and ‘fingerprick’ blood glucose and ketone measurements in the early assessment of patients with suspected T1DM and known T1DM, particularly if risk factors for DKA are present, to minimise serious complications and prevent fatal outcomes. Urgent referral to specialist centres for suspected new onset T1DM/DKA is required. Specific steps should be followed to ensure successful initial management of DKA in the nonspecialist setting before transfer.

The aim of this review is to provide information to improve the early recognition of diabetic ketoacidosis (DKA) and to provide guidelines for the initial management of DKA in the nonspecialist setting. Questions to be answered are:

  • Is the patient at risk of DKA?
  • Are there clinical symptoms suggestive of DKA?
  • What are the initial investigations needed?
  • What is the initial therapy?
  • Who needs to be contacted?
  • What does the specialist treatment include?
  • How will the patient be followed up?

Two typical scenarios are described in Case study 1 and 2.

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Correspondence afp@racgp.org.au

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