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Diabetic Ketoacidosis Management in Children

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1. Diabetic Ketoacidosis Management in Children

Diabetic Ketoacidosis Management in Children Diabetic Ketoacidosis Management in Children Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Diabetic Ketoacidosis Management in Children Diabetic Ketoacidosis Management in Children Aka: Diabetic Ketoacidosis Management in Children , Pediatric DKA Treatment From Related Chapters II. Management: Phase 1 - Fluids in Children (Emergent) Stabilize shock and states first! Correct Volume Deficit Initial Give 10-20 cc/kg NS bolus over first 45 minutes Repeat fluid bolus until shock corrected Next Fluid deficit replacement distributed evenly over 48 hour period Start with NS and transition

2018 FP Notebook

2. Acute Kidney Injury in Children With Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis. (PubMed)

Acute Kidney Injury in Children With Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis. Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined.To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI.This medical record review of all (...) , management, and follow-up of AKI in children with type 1 diabetes.

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2017 JAMA pediatrics

3. Diabetes (type 1 and type 2) in children and young people: diagnosis and management

(https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 852.4 Dietary advice based on glycaemic index for children and young people with type 1 diabetes from diagnosis 55 2.5 Optimal dosage of intravenous insulin for managing diabetic ketoacidosis in children and young people 56 More information 56 Update information 57 Recommendations from NICE guideline CG15 that have been amended 57 Strength of recommendations 84 Diabetes (type 1 and type 2) in children and young people (...) to significant diabetic kidney disease annual monitoring (see recommendation 1.3.43) is important because, if diabetic kidney disease is found, early treatment will improve the outcome. [new 2015] [new 2015] Diabetic ketoacidosis Measure capillary blood glucose at presentation in children and young people without known Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Assessment of platelets morphological changes and serum butyrylcholinesterase activity in children with diabetic ketoacidosis: a case control study. (PubMed)

Assessment of platelets morphological changes and serum butyrylcholinesterase activity in children with diabetic ketoacidosis: a case control study. Many studies indicated that mean platelet volume (MPV) and platelet distribution width (PDW) may be valuable in the diagnosis and management of clinical disorders; also, serum butyrylcholinesterase activity (BChE) was suggested to be linked to systemic inflammation and oxidative stress. Limited studies measured these readily available markers (...) in children with diabetic ketoacidosis (DKA). Our objectives were to measure MPV, PDW and BChE in children with DKA; and to assess if any of these markers reflects the severity of DKA.Our study included: 30 children with DKA (DKA group), 30 diabetic children (Non-DKA group) and 30 apparently healthy children (control group). MPV, PDW and BChE were measured in all children. Additional blood samples were withdrawn from the DKA group to assess these markers at discharge from hospital.MPV, PDW and BChE were

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2017 BMC Endocrine Disorders

5. Comparison of subcutaneous insulin aspart and intravenous regular insulin for the treatment of mild and moderate diabetic ketoacidosis in pediatric patients. (PubMed)

 ± 0.8 for intervention and 8.86 ± 0.7 for control group (p = 0.4) with 64% having moderate diabetic-ketoacidosis. The mean total-dose of insulin units needed for treatment of diabetic-ketoacidosis in intervention (subcutaneous insulin aspart) was lower than controls (intravenous regular insulin) (p < 0.001). No mortality/serious events happened. Three diabetic-ketoacidosis recurrences among interventions and one among controls occurred.To manage mild/moderate diabetic-ketoacidosis in children (...) Comparison of subcutaneous insulin aspart and intravenous regular insulin for the treatment of mild and moderate diabetic ketoacidosis in pediatric patients. To compare the safety/efficacy of intermittent subcutaneous rapid-acting insulin aspart with the standard low-dose intravenous infusion protocol of regular insulin for treatment of pediatric diabetic-ketoacidosis.For a prospective randomized-controlled clinical trial on 50 children/adolescents with mild/moderate diabetic-ketoacidosis

2019 Endocrine

6. Diabetic Ketoacidosis Management in Adults

Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Aka: Diabetic Ketoacidosis Management in Adults , DKA Management From Related Chapters II. Management: Phase 1 - Fluids in Adults (Emergent) Stabilize shock and states first! Disconnect Removes the risk of uncalculated additional admininistered from pump (risk of ) Clearly, pump is not working properly if the patient is presenting in Remove needle from insertion site and observe for needle or tubing problem

2018 FP Notebook

7. Plasma Copeptin Levels in Children With Diabetic Ketoacidosis

Plasma Copeptin Levels in Children With Diabetic Ketoacidosis Plasma Copeptin Levels in Children With Diabetic Ketoacidosis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Plasma Copeptin Levels in Children (...) , Montpellier Study Details Study Description Go to Brief Summary: Children with diabetic ketoacidosis risk neurological complications such as cerebral edema with high morbidity. To prevent cerebral edema, it is essential to control correction of hypovolemia, hyperglycemia and natremia. Markers usually used in management of diabetic ketoacidosis don't always permit an optimal care. Plasma copeptin levels reflect vasopressin secretion which is high in diabetic ketoacidosis. Therefore, monitoring of plasma

2016 Clinical Trials

8. Evaluation of the Cerebral Edema in Children Having Diabetic Ketoacidosis

Evaluation of the Cerebral Edema in Children Having Diabetic Ketoacidosis Evaluation of the Cerebral Edema in Children Having Diabetic Ketoacidosis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Evaluation (...) of the Cerebral Edema in Children Having Diabetic Ketoacidosis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02937441 Recruitment Status : Completed First Posted : October 18, 2016 Last Update Posted : February 4, 2019 Sponsor: Cukurova University Information provided by (Responsible Party): Ozlem Tolu

2016 Clinical Trials

9. A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes (PubMed)

A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates (...) use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD

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2015 Journal of diabetes research

10. Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. (PubMed)

Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. The Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS) for Inpatient Care guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings are available in full at: www.diabetes.org.uk/joint-british-diabetes (...) hypoglycaemia, and the safe use of insulin. Finally, clinical teams should ensure that all staff can access training in diabetes and mental health to support them to care for people with both diabetes and severe mental illness, develop local pathways for joint working and ensure best practice tariff criteria are met for diabetic ketoacidosis and hypoglycaemia, and for children and young people with diabetes.© 2018 Diabetes UK.

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2018 Diabetic Medicine

11. Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis (PubMed)

Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis The triad of pancreatitis, hypertriglyceridemia, and diabetic ketoacidosis and its treatment has not been extensively discussed in the pediatric literature. We report a 4-year-old child with severe hypertriglyceridemia, pancreatitis, and diabetic ketoacidosis. Hypertriglyceridemia and pancreatitis with diabetic ketoacidosis can be successfully managed (...) with insulin and hydration therapy in children. Early recognition of this triad is important as insulin requirements, recovery duration, and prognosis can be altered.

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2017 Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

12. Pediatric Diabetic Ketoacidosis With Hypotensive Shock and Rash-An Unusual Presentation. (PubMed)

Pediatric Diabetic Ketoacidosis With Hypotensive Shock and Rash-An Unusual Presentation. We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.

2018 Pediatric Emergency Care

13. Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers (PubMed)

Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study (...) is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines.We performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA.A total of 100 patients were included in the analysis. Thirty-seven percent of patients with DKA were managed according to all six guideline parameters. Only 39% of patients received the recommended hourly blood glucose checks. Thirty percent

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2017 International journal of emergency medicine

14. Diabetic Ketoacidosis

Diabetic Ketoacidosis Julie A Edge, Oxford: Approved by BSPED Clinical Committee 26/8/2015 BSPED Recommended Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis 2015 These guidelines for the management of DKA in children and young people under the age of 18 years are based on the NICE guideline for Type 1 and Type 2 diabetes in children and young people [published August 2015, recommendations 1.4.1 to 1.4.66]. During the development (...) with careful monitoring and management Aspiration pneumonia Use a naso-gastric tube in semi-conscious or unconscious children Julie A Edge, Oxford: Approved by BSPED Clinical Committee 26/8/2015 Guidelines for the Management of Diabetic Ketoacidosis CONTENTS Page A. Diagnosis 1 B. Emergency management in A&E 2 1. Resuscitation 2 2. Fluid bolus 2 3. Investigations 2 C. Full Clinical Assessment 3 1. Conscious level 3 2. Full Examination 3 Where should the child be nursed? 3 D. Management 4 1. Fluids - volume

2015 British Society for Paediatric Endocrinology and Diabetes

15. Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis (PubMed)

Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We (...) have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end

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2016 Journal of diabetes research

16. ABCD position statement on standards of care for management of adults with type 1 diabetes

and monitoring 4.1 Treatment 4.2 Targets 4.3 Monitoring 4.4 Unexplained or unpredictable blood glucose results 5. Long term complications: screening and management 5.1 Screening and treatment for microvascular complications 5.1.1 Retinopathy 5.1.2 Nephropathy 5.1.3 Neuropathy 5.2 Screening and risk factor modification for macrovascular disease 3 6. Acute complications 6.1 Hypoglycaemia 6.2 Diabetic ketoacidosis 7. Special circumstances 7.1 Children and young adults 7.2 Older people and care homes 7.3 (...) guideline for the management of Diabetic Ketoacidosis in Adults. https://www.diabetes.org.uk/.../The-Management-of-Diabetic- Ketoacidosis-in -Adults/ 24 Children and young people under the age of 18 years should be treated according to the British Society of Paediatric Endocrinology and Diabetes (BSPED). http://www.bsped.org.uk/clinical/docs/DKAguideline.pdf_ Follow up after resolution of DKA All people with DKA should be reviewed by the diabetes specialist team (an audit criterion) for: ? Education

2017 Association of British Clinical Diabetologists

17. Hypertension management and renin-angiotensin-aldosterone system blockade in patients with diabetes, nephropathy and/or chronic kidney disease

diabetes 5 © Association of British Clinical Diabetologists 2017 Recommendations The following are recommendations for renin-angiotensin-aldosterone system (RAAS) blockade and hypertension management in patients with type 1 diabetes. 1 In patients with type 1 diabetes and normoalbuminuria, we suggest a threshold for blood pressure therapy of a persistent upright (sitting or standing) blood pressure that is greater than or equal to 140/80 mmHg (Grade 2D). In children and adolescents with type 1 diabetes (...) and nephropathy is unclear. Small cohort studies of children and adults with type 1 diabetes suggest that an increase in nocturnal systolic blood pressure or blunting of nocturnal dipping is an important factor in progression to microalbuminuria in patients with type 1 diabetes. 25,26 Due to a lack of robust evidence, no guidelines currently recommend ambulatory or home blood pressure monitoring to diagnose or manage hypertension in patients with type 1 diabetes, although the ISPAD guidelines suggest

2017 Association of British Clinical Diabetologists

18. Management of Diabetes Mellitus in Primary Care

Management of Diabetes Mellitus in Primary Care VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN PRIMARY CARE Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision-making. They are not intended to define a standard of care (...) for specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 5.0 – 2017 April 2017 Page 1 of 160 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care April 2017 Page 2 of 160 Prepared by: The Management of Type 2 Diabetes Mellitus

2017 VA/DoD Clinical Practice Guidelines

19. Type 2 diabetes in adults: management

cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. The guideline does not cover diagnosis, secondary diabetes, type 1 diabetes in adults, diabetes in pregnancy and diabetes in children and young people. Reasons for the update Since the publication of the 2009 guideline, availability of new evidence and several key developments have prompted an update in the following areas: managing blood glucose levels, antiplatelet therapy and erectile dysfunction (...) Type 2 diabetes in adults: management T T ype 2 diabetes in adults: management ype 2 diabetes in adults: management NICE guideline Published: 2 December 2015 nice.org.uk/guidance/ng28 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

20. Diabetes in pregnancy: management from preconception to the postnatal period

mmol/litre. [new 2015] [new 2015] T est urgently for ketonaemia if a pregnant woman with any form of diabetes presents with hyperglycaemia or is unwell, to exclude diabetic ketoacidosis. [new 2015] [new 2015] Diabetes in pregnancy: management from preconception to the postnatal period (NG3) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 55At antenatal appointments, provide care specifically for women (...) . [2015] [2015] Diet, dietary supplements and body weight Diet, dietary supplements and body weight 1.1.9 Offer women with diabetes who are planning to become pregnant individualised dietary advice. [2008] [2008] 1.1.10 Offer women with diabetes who are planning to become pregnant and who have a BMI above 27 kg/m 2 advice on how to lose weight, in line with the NICE guideline on obesity: identification, assessment and management of overweight and obesity in children, young people and adults [2

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

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