Fig 6: Patients with DKA can be critically ill at presentation and should be managed systematically
Airway, breathing and circulation form part of the initial emergency management of paediatric DKA [22,25]:
Airway
Ensure patent
Consider adjuncts or definitive airway if indicated
Seek anaesthetic support if there are concerns
Due to the high risk of aspiration pneumonia an NG tube should be seriously considered in the following situations:
a child with reduced level of consciousness
and/or recurrent vomiting
& or recent consumption of a large volume of fruit juice or high sugar drinks[28-29]
Breathing
Give 100% oxygen by non re-breathe mask
Circulation
Obtain IV access
Ideally 2 points of access
Avoid central access due to increased risk of thrombus
Attach patient to a cardiac monitor[30,31]
Perform a 12 lead ECG, and evaluate for T wave changes, and assess for signs of shock
All patients should be given fluid replacement and this should occur before insulin/immediately. The amount of fluid is dependant on if they are shocked: