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

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.

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