Pediatric Diabetic Ketoacidosis and Hypoglycemia

2020 ◽  
Author(s):  
Rachel J Williams ◽  
Samantha L. Wood
Keyword(s):  
Emergency Department ◽  
Key Words ◽  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Cerebral Edema ◽  
Critically Ill Patients ◽  
Pediatric Patients ◽  
Serum Glucose ◽  
Neurologic Function ◽  
Threat To Life

Abnormalities of serum glucose in pediatric patients are commonly encountered in the emergency department and represent an acute threat to life and neurologic function. Rapidly identifying and aggressively treating hyperglycemia with diabetic ketoacidosis and hypoglycemia are critical to ensure the best possible outcome. This review will guide the emergency provider in the identification, resuscitation, workup, and disposition of these critically ill patients. This review contains 6 figures, 13 tables, and 50 reviews. Key Words: Cerebral edema, diabetic ketoacidosis, hyperglycemia, hypoglycemia

Patient Distribution of an Urban-Rural Emergency Medical Services System

1990 ◽  
Vol 5 (2) ◽  
pp. 119-129 ◽  
Author(s):  
Michael S. Jastremski ◽  
Ronald J. Lagoe
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Distribution System ◽  
Limiting Factor ◽  
Urban Rural ◽  
One Year ◽  
Universal Applicability ◽  
Hospital Emergency Departments

AbstractThis study describes a series of mechanisms to alleviate overcrowding of hospital emergency departments by distributing critically ill patients among facilities with available resources. The initial mechanism, which was based on the availability of critical care beds, was used successfully between 1982 and 1986, but had to be abandoned when several new factors caused the availability of emergency department resources to become the limiting factor. A second approach, based on the availability of critical care and emergency department resources, produced limited success over a one-year period. The system currently in use, implemented in 1989, includes a distribution system based on the availability of emergency department resources and critical care beds, as well as a mechanism for diversion of ambulances to hospitals in neighboring counties at times of extremely high utilization. This experience demonstrates that mechanisms for planning the distribution of emergency and critically ill patients have universal applicability.

scholarly journals Treatment of Pediatric Diabetic Ketoacidosis in Canada: A Review of Treatment Protocols from Canadian Pediatric Emergency Departments

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Steven A Skitch ◽  
Rahim Valani
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Treatment Guidelines ◽  
Treatment Protocol ◽  
Serum Glucose ◽  
National Guidelines ◽  
Fluid Bolus ◽  
Treatment Protocols ◽  
Maintenance Fluid ◽  
Potassium Replacement

ABSTRACTObjectiveDiabetes is the most common pediatric endocrine disorder, and diabetic ketoacidosis (DKA) is the leading cause of diabetes-related morbidity and mortality. This article reviews pediatric DKA treatment protocols from across Canada and identifies similarities and differences.MethodsPediatric tertiary centres in Canada were asked for a copy of their DKA treatment protocol. For each protocol, we collected information on the amount of initial fluid bolus, maintenance fluid rate, insulin infusion rate, potassium replacement, monitoring and adjustment for serum glucose, administration of bicarbonate, and treatment for cerebral edema.ResultsResponses were obtained from 13 sites. Treatment guidelines were consistent in their recommendations on timing and dosage of intravenous insulin, potassium replacement, monitoring and adjusting for serum glucose, and management of cerebral edema. Variability in treatment protocols was found chiefly in volume of initial fluid bolus (range: 5–20 mL/kg) and length of time boluses should be administered (20–120 min), maintenance fluid rates (based on weight or a 48-hr deficit), and the role of bicarbonate administration.ConclusionsThis is the first review of treatment protocols for pediatric DKA in Canada. It identified many common approaches but noted specific differences in fluid boluses, maintenance fluid rates, and bicarbonate administration. The extent of variation indicates the need for further study, as well as national guidelines that are evidence-based and consistent with best practices.

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