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Diabetic ketoacidosis in paediatrics: tools to assist in recognition of a sick child

02 July 2021
Volume 13 · Issue 7


Diabetic ketoacidosis (DKA), a complication of diabetes, is a medical emergency in children and is one of the main causes of childhood mortality. It is the first presentation of diabetes in 30–40% children with the condition, and is more common in younger children. However, it is commonly misdiagnosed as the signs and symptoms in children vary. Treatment should be given as soon as possible, and this is usually only possible in a hospital setting. Therefore, early recognition and transportation to hospital by paramedics ensures the best possible outcome. Children are far more likely to have type 1 than type 2 diabetes, and several factors are associated with childhood diabetes, including genetics, medication, viral infections and environmental issues. Several tools and guidelines can be used to assess children prehospitally. These should be used in conjunction with the clinician's knowledge and standard observations. Paramedics should take an appropriate history, as this could prove invaluable for hospital specialists.

The UK has the highest prevalence of children and young people with type 1 diabetes in Europe (Iacobucci, 2013). In 2019 in England, 26 018 children with type 1 diabetes presented to hospital with diabetes-related illnesses; 2.5% of these were experiencing diabetic ketoacidosis (Royal College of Paediatrics and Child Health, 2019).

Childhood diabetes is associated with a variety of risk factors such as geographical location, which means their parents might find it difficult to access medical care or other services. They may also have a lower socioeconomic status which means they may find it harder to take time off work, and be more likely to have a poor diet and poor parental education (Wolfsdorf et al, 2018). Children who live in more deprived areas have a higher instance of childhood diabetes and diabetic complications (Lissauer and Carroll, 2018). This is because of a lack of support, and poor management and diabetic control. Tight diabetic control reduces the risk of long-term complications (Lissauer and Carroll, 2018).

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