Type 1 diabetes in children - emergency management.
BACKGROUND
Fifteen to sixty-seven percent of patients with new onset type 1 diabetes mellitus (T1DM) present in diabetic ketoacidosis (DKA), of which approximately 79% initially see their general practitioner. Diabetic ketoacidosis is the most common cause of diabetes related deaths, mainly due to cerebral oedema that occurs in 0.4-3.1% of patients.


OBJECTIVE
The aim of this review is to provide information to improve the early recognition of DKA and to provide guidelines for the initial management of DKA in the nonspecialist setting.


CONCLUSIONS
Recognition of DKA can be improved by increasing the awareness for early clinical symptoms such as polyuria and polydipsia. It is important to include urinalysis and 'fingerprick' blood glucose and ketone measurements in the early assessment of patients with suspected T1DM and known T1DM, particularly if risk factors for DKA are present, to minimise serious complications and prevent fatal outcomes. Urgent referral to specialist centres for suspected new onset T1DM/DKA is required. Specific steps should be followed to ensure successful initial management of DKA in the nonspecialist setting before transfer.
Siafarikas
Aris
A
Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia. aris.siafarikas@health.wa.gov.au
O'Connell
Susan
S
D000293:Adolescent; D001315:Australia; D001774:Blood Chemical Analysis; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D042241:Early Diagnosis; D004630:Emergencies; D005194:Family Practice / Q000592:standards / Q000639:trends; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016482:Urinalysis
D001786:Blood Glucose; D007328:Insulin