Pediatric Diabetic Ketoacidosis

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So I have just started my pediatric clinical rotation and rather than doing our process paper on a real patient, we have to make one up. The disease I was assigned is diabetes. This is the story of my patient from admission to my date of care:

My patient is a 12 year old girl who was diagnosed with type 1 diabetes one year ago and has a family history of diabetes. She was admitted to the ER early wednesday morning. She was drowsy and complained of feeling thirsty and having diffuse abdominal pain and had been vomiting for 2 days. She was tachycardic, clinically dehydrated and breathing very deeply. A CBC, BMP, ABG, urinalysis, and cardiac monitoring were ordered. Abnormal results = potassium 3.2, sodium 130, pH 7.30, HCO3 22, and urine positive for ketones and glucose. Her fingerstick is 300. She was diagnosed with diabetic ketoacidosis and the doctor ordered IV fluids at 73 ml/hr, advance to oral fluids as tolerated, infuse insulin loading dose of 2.9 units followed by continuous infusion of 2.9 units/hour, K+ protocol, FS every hour. As glucose approaches 250, add 5% dextrose to IV fluids.

I have never had this type of patient, but this is the information i've gathered from my books. I'd like to know if I am on the right track and at what point would a patient like this would be transferred from the ER to the pediatric unit?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

once the diagnosis was made and the initial meds given IVF started insulin gtt started they would be sent to the monitored unit. Insulin gtt are sent to the ICU at some facilities

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Thank you :)

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Specializes in NICU, ICU, PICU, Academia.

Hourly glucose monitoring and insulin drips are managed in the PICU at our facility as well. Is the insulin drip weight based? It should be. Does she use a pump at home? Last A1C? Still getting her basilar insulin injection?

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I would start with a sound understanding of what I consider a somewhat nerve wrecking but awesomely fun pathophysiology of DKA.

Do you understand why fluid replacement is important?

What cellular exchange leads to the hypokalemia?

What about adolescents with DM1 places them at risk to develop DKA? (think peer pressure/wanting to fit in)

What is your priority? Look at the labs, what stands out? What is the BIG issue with DKA? What's the next biggest concern?

Your professors didn't provide more assessment data? Skin turgor? Cardiac monitoring? Urine output? Psychosocial assessment?

I see she's thirsty, why do you think she's thirsty?

What about her respirations. What about them is unique to DKA?

Edit: I'm confused. Is your assignment to make a nursing process over this made up scenario? Or Did you make the scenario? Was that your assignment? :so confused:

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Sorry to confuse you. My assignment is to write a nursing process paper on an imaginary pediatric patient with diabetes. These were my only guidelines, so I did make up the scenario. I do have to evaluate labs, assessments, pathophysiology, etc. later in my paper. The paragraph I submitted above is supposed to be a description of what happened to my patient from the time they were admitted to the hospital to the time they came into my care.

So what I wanted to know was if it made sense and when a patient like this would be transferred to the unit

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Sorry to confuse you. My assignment is to write a nursing process paper on an imaginary pediatric patient with diabetes. These were my only guidelines, so I did make up the scenario. I do have to evaluate labs, assessments, pathophysiology, etc. later in my paper. The paragraph I submitted above is supposed to be a description of what happened to my patient from the time they were admitted to the hospital to the time they came into my care.

So what I wanted to know was if it made sense and when a patient like this would be transferred to the unit

When I was in MICU for clinical there were quite a few of pts on insulin gtts. Never once had a pt on insulin gtt on medsurg.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sorry to confuse you. My assignment is to write a nursing process paper on an imaginary pediatric patient with diabetes. These were my only guidelines, so I did make up the scenario. I do have to evaluate labs, assessments, pathophysiology, etc. later in my paper. The paragraph I submitted above is supposed to be a description of what happened to my patient from the time they were admitted to the hospital to the time they came into my care.

So what I wanted to know was if it made sense and when a patient like this would be transferred to the unit

http://peds.stanford.edu/Rotations/endocrinology/pdfs/endo_article_dka_in_picu.pdf

It makes sense...however the IV would probably be faster to counter act the dehydration. I think this will help you...a lot....http://www.luhs.org/depts/emsc/peddka_pdf.pdf

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Specializes in Pedi.

I don't think this kid is getting enough fluid. 73 mL/hr would be maintenance fluids for a child weighing 33 kg. That would be quite small for a 12 yr old. The typical insulin dosage I've seen in ketoacidosis is 0.1 u/kg/hr. So the dose you have listed is for a child weighing 29 kg. How much does the patient weigh? This is an important factor in pediatrics. And if you have a 12 yr old who weighs 29 kg, that's a big problem (less than 5th percentile for weight) and her diabetes has been poorly controlled for a while. If she weighs 33 kg, she's still only in the 10th percentile for weight and then the insulin dosage is wrong. Either way, if she's dehydrated she needs more than maintenance fluids.

Q1hr anything belongs in the ICU.

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