2. Presentation
Clinical signs
Investigations
Treatment
Etc

3. DKA is Scary Rare Presentation: Sick  Comatose
Little people are scary anyway
Complex management
Constantly changing
Bad experience with DKA

4. Definition: Bsped

5. Just treat Children like Little Adults

6. Really Don’t...Not with DKA
Treat Children like adults in
Trauma
TBI
Sepsis
Seizures
Don’t in:
Acute wheeze
Cardiac
DKA

7. LP1: Never use an Adult DKA protocol on a child
I promise this gets less scary...
(LP = learning point)

8. Concentration of protein in human newborn CSF is higher than in the adult (Spiegel-Adolf et al., 1954; Nasralla et al., 1958)

9. BBB permeability with DKA treatment
Study small numbers, and insulin rate 0.1
Pediatr Crit Care Med May; 11(3): 332–338.

10. BBB permeability with DKA treatment

12. Use an Age Specific DKA protocol

13. Make Calc easy

15. ‘Paeds DKA protocols are Laborious’ LP 2- Get a separate person to do the Calcs

16. When do I call for help

17. Easy: As soon as you think it
Age <16
But also <18
Neuro signs
20mls/kg Fluid bolus
Guide treatment

18. What are all the things I need

19. (LP) It’s not what you give It’s how you give it

20. I get confused what Fluids to give & When
LP- Normal Saline (with KCL)
6. Continuation of 0.9% sodium chloride (instead of changing to 0.45% sodium chloride) for the full duration of rehydration (BSPED)

21. Never Intubate? CO2 control is very challenging
Takes away neuro monitor
Don’t intubate unless GCS < 8*
*After fluids have been commenced

22. Fluid Resus is Bad!

23. Golden Rule:
Sit on your Hands

25. Challenges Distance Observation 2nd pathology Different protocols
Changing rates – fluids & insulin

27. SS Guidelines

28. https://pathways. nice. org

29. What they all agree on No Fluid bolus for mild or moderate DKA
Subtract Bolus over 20ml/kg from
Normal Saline in Rehydration phase
Rehydration phase over 48 hours
Fluids before Insulin
Insulin after 1-2 hours
Maintain insulin rate until ketones <3mmol/l
Add glucose if BG <14mmol/l
Hourly obs

30. If only it were that simple

31. Variances Fluids Insulin Max dehydration correction Maintainence Calcs
10% BSPED
8% Edinburgh
Maintainence Calcs
0.1 units/kg/hr
0.05
0.03

32. Bottom line Pick one and stick with it
(SS reference would be BSPED)

34. Summary Use an age specific protocol
And stick to one
Call for help if you are concerned
Have a second person work out calcs
Normal saline (with KCl) only
Intubate only if necessary
Sit on your hands