RT Book, Section A1 Yamamoto, Loren G. A2 Tenenbein, Milton A2 Macias, Charles G. A2 Sharieff, Ghazala Q. A2 Yamamoto, Loren G. A2 Schafermeyer, Robert SR Print(0) ID 1155427763 T1 Diabetes Mellitus and Hypoglycemia T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 5e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259860751 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1155427763 RD 2024/10/10 AB Diabetic ketoacidosis (DKA) is a complex endocrine condition caused by an absolute or relative lack of insulin. It is characterized by hyperglycemia, dehydration, ketosis, and metabolic acidosis.DKA is often insidious in onset, with slow progression of the illness.Definition of DKA by biochemical criteria includes the following:Hyperglycemia: Blood glucose >200 mg/dLVenous pH 600 mg/dLArterial pH >7.30Serum bicarbonate >15 mmol/LSmall ketonuria and absent or mild ketonemiaSerum osmolarity >320 mOsm/LStupor or comaNewborns and young infants with hypoglycemia may be asymptomatic or may manifest nonspecific symptoms. Older children exhibit more classic symptoms of hypoglycemia, including sweating, tachycardia, tremor, anxiety, tachypnea, and weakness.Treatment of hypoglycemiaIn newborns, give 10% dextrose 2 mL/kg (0.2 g/kg) as a bolus, followed by infusion at 6 to 9 mg/kg/min.In children, give 10% dextrose at 5 mL/kg (0.5 g/kg) as a bolus, followed by continuous infusion at 6 to 9 mg/kg/min. Alternatively, follow the “50 rule” in which the mL/kg multiplied by the dextrose % equals 50. For example, 1 mL/kg of D50, 2 mL/kg of D25, 5 mL/kg of D10, etc.If an intravenous (IV) line is not possible, then give glucagon 0.03 mg/kg (maximum dose 1 mg) subcutaneously.Admission of the hypoglycemic patient is indicated when there is no obvious cause, toxic ingestion as with oral hypoglycemic agents is suspected, administration of long-acting insulin was the cause, or if there are persistent neurological deficits.