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Diabetic Ketoacidosis in Children

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a buildup of acids in the blood. It is a life-threatening complication resulting from not having enough insulin. It may happen if your child has type 1 diabetes. (It rarely happens with type 2 diabetes.) It is an emergency that must be treated right away. If ketoacidosis is not treated right away, it can cause diabetic coma or death.

What is the cause?

Diabetic ketoacidosis happens when your child’s body does not have enough insulin. Without insulin, sugars in the blood cannot move out of the blood and into the body’s cells, and so the cells burn fats instead of sugar for energy. The burning of fats makes byproducts called ketones. The ketones build up to poisonous and dangerous levels in the blood. High blood sugar often happens at the same time as ketoacidosis because sugar also builds up in the blood.

When ketoacidosis happens, it may mean that your child’s diabetes is not in good control, or that your child may be getting an infection. Ketoacidosis may happen even though your child’s blood sugar is usually in good control if there is a change in your child’s life, such as:

  • Infection
  • Injury
  • Surgery
  • Other types of physical or emotional stress

Sometimes the diagnosis of diabetes is not made until ketoacidosis occurs. When your child has type 1 diabetes, the pancreas stops making insulin. When this happens, ketones can build up to a high level very fast. It may happen so fast that ketoacidosis symptoms are the first symptoms of diabetes.

What are the symptoms?

If your child has ketoacidosis, symptoms may include:

  • Shortness of breath
  • Fruity-smelling breath
  • Very dry mouth
  • Nausea and vomiting

Symptoms of high blood sugar may include:

  • Blurry vision
  • Dry mouth
  • Feeling very thirsty and drinking a lot
  • Urinating a lot
  • Tiredness

The ketoacidosis symptoms leading to a diabetic coma usually happen gradually. In most cases it takes several hours to a couple of days for ketoacidosis to cause a diabetic coma.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child’s provider will pay special attention to:

  • Possible infection
  • The amount of fluids in your child’s body
  • How clearly your child is thinking
  • Your child’s breathing
  • How well your child’s heart and kidneys are working

Your child’s provider will do some tests to check the levels of sugar and other chemicals in your child’s blood. Your child may have other lab tests, a chest X-ray, and an ECG.

How is it treated?

Ketoacidosis needs to be treated right away. Treatment is usually given at a hospital.

  • Your child will be given insulin as soon as ketoacidosis is diagnosed.
  • Your child’s blood will be checked often for sugar levels and chemical balances.
  • Your child will be given IV fluids.

Ketoacidosis will continue until the insulin and fluids have restored a balance of chemicals in your child’s body. With treatment, your child will usually recover in hours to days.

How can I take care of my child and help prevent diabetic ketoacidosis?

To help take care of your child and prevent ketoacidosis, follow these guidelines:

  • Keep your child’s blood sugar level under control, as recommended by your child’s healthcare provider.
  • Make sure your child eats a healthy diet.
  • Follow the physical activity or exercise plan your child’s healthcare provider has recommended.
  • Check your child’s blood sugar level as often as your child’s provider recommends.
  • Make sure your child never takes more insulin than the regular dose unless you have double checked the blood sugar reading and made sure that the sugar level is too high and your child needs more insulin.
  • Know the early signs and symptoms of ketoacidosis.
  • Ask your healthcare provider when you should check for ketones. Your provider may recommend checking for ketones if:
    • Your child’s blood sugar level is higher than 240 mg/dL (about 13.9 mmol/L).
    • Your child is ill or under more stress than usual. When your child is sick, ketones can be present even if the blood sugar is not high.

    Check your child’s blood sugar more often if you think your child is getting sick.

  • Keep extra insulin with your child.
  • Have your child carry an ID (such as a card or bracelet) that says he or she has diabetes, in case of an emergency.

Call your child’s healthcare provider right away if:

  • Your child has type 1 diabetes and a urine test shows that there are ketones in the urine.
  • Your child has a fever or other symptoms of an infection, such as flu or a bladder infection.
  • Your child has been vomiting and cannot keep food and fluids down.
  • Your child’s blood sugar has been over 240 mg/dL (over 13 mmol/L) before meals for more than 1 day, especially if your child is also vomiting or has other symptoms of illness or ketoacidosis.
Developed by RelayHealth.
Pediatric Advisor 2013.2 published by RelayHealth.
Last modified: 2013-02-11
Last reviewed: 2013-02-09
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2013 RelayHealth and/or its affiliates. All rights reserved.
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