Diabetic Ketosis in child...

A girl, age 8 years, weight 20 kg, came to the emergency room with complaints of shortness of breath that had worsened since 6 hours ago. Four months ago she was diagnosed with diabetes mellitus and received insulin treatment. One day ago the patient experienced vomiting and severe abdominal pain. She became incontinent 1 hour ago. When she came to the emergency room, the patient responded to voice stimulation, BP 80/40 mmHg, HR 135x/min, palpable but weak, RR 50x/min fast and deep, capillary filling time is 3 seconds.

Supporting examination: GDS 769 mg/dL, blood ketone 7; blood pH 7.01, HCO3 4.0, BE -15, serum Na+ 129 mEq/L, serum K+ 5.8 mEq/L.

The patient was diagnosed with severe diabetic ketoacidosis (DKA) in type 1 diabetes mellitus and hypovolemic shock. the management given was initial fluid (loading) with NaCl 0.9% 20 mL/kg (400 mL). maintenance fluid given after the shock is resolved: Dextrose 10% + KCl 20 mEq/golf and NaCl 0.9% + KCl 20 mEq/golf (two bags system). Insulin drip in the form of rapid acting insulin 0.05-0.1 units/kg/hour = 1-2 units/hour equivalent to 24-48 units in 24 hours (insulin dilution: 10 mL of 0.9% NaCl for 1 unit of insulin ~ 250-500 mL of 0.9% NaCl for 24-48 units of rapid acting insulin). Evaluation and monitoring is carried out every hour for the following: blood glucose check, Every 4 hours, Blood Gas analysis check, electrolytes, blood ketones, fluid balance and diuresis, The target of reducing Blood glucose level does not exceed 100 mg/dL every hour, Insulin drip is stopped and peroral intake is started if metabolically stable, Regular (rapid) insulin is then given subcutaneously at a dose of 0.5-1 units / kgBB / day divided by 40% basal and 60% bolus. Stop IV insulin after 1 hour of subcutaneous insulin. Check HbA1c to evaluate metabolic control.