early management and assessment
Last reviewed 01/2018
Paediatric patients who presents with a hyperglycemic crisis will be managed in A&E and includes the following:
- general resuscitation
- airway
- ensure that the airway is patent and if the child is comatose, insert an airway
- if consciousness reduced or child has recurrent vomiting, insert N/G tube, aspirate and leave on open drainage
- breathing
- give 100% oxygen by face-mask.
- circulation
- insert IV cannula and take blood samples for initial investigations
- cardiac monitor for T waves (peaked in hyperkalaemia)
- unshocked patient is started on 0.9% saline
- if the child is in shock (poor peripheral pulses, poor capillary filling with tachycardia, and/or hypotension) give 10 ml/kg 0.9% (normal) saline as a bolus, and repeat as necessary to a maximum of 30 ml/kg.
- confirmation of the diagnosis
- history - polydipsia, polyuria
- clinical - acidotic respiration, dehydration, drowsiness, abdominal pain/vomiting
- biochemical - high blood glucose on finger-prick test (>11 mmol/l), blood pH < 7.3 and /or HCO3< 15 mmol/l, finger prick blood ketones >3.0 mmol/l, glucose and ketones in urine
- initial investigations
- blood glucose
- urea and electrolytes (electrolytes on blood gas machine give a guide until accurate results available)
- blood gases (venous blood gives very similar pH and pCO2 to arterial)
- near patient blood ketones if available (superior to urine ketones)
- other investigation if clinically indicated e.g. PCV and FBC, CXR etc (1)
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