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Pediatric Diabetic Ketoacidosis - Risk Factors & Pathophysiology, Management Strategies & Outcomes (Hardcover)
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Pediatric Diabetic Ketoacidosis - Risk Factors & Pathophysiology, Management Strategies & Outcomes (Hardcover)
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The future of persons with Type 1 Diabetes Mellitus is continuing
to "look brighter" with the advent of biomedical technology.
Nevertheless, the acute consequences of this disease remains a
significant threat. Diabetic ketoacidosis [DKA] remains the most
serious challenge for primary care physicians and subspecialists
caring for children and young persons with Diabetes Mellitus. Its
prevention is possible only among those already diagnosed.
Awareness of the etiology and clinical presenting signs among
children of all ages is requisite for primary care and emergency
department staff [Chapter 1]. While more likely to occur among
those with Type 1 diabetes, a significant proportion of children
with Type 2 diabetes are also at risk [Chapter 3]. Once diagnosed,
the physician team must understand not only what biochemical
imbalances must be corrected, but also what life-threatening
complications must be avoided [Chapter 1]. The path through that
"maze" is not yet fully interpreted; many choices remain as
options, but each must be carefully evaluated. Diagnosis among the
very young is a challenge because of they lack self-awareness and
clarity of signs and symptoms [Chapter 2]. Education of the primary
care staff is critical and able to alter the incidence of DKA at
the time of diagnosis. Institutions that treat children and
adolescents with DKA need an informed Emergency Department as well
as Pediatric Intensive Care Facilities. Access to appropriate
consultations, such as pediatric endocrinology, cardiology,
neurology and neurosurgery are crucial. The initiation of care is
critical, and occurs invariably in the Emergency Department
[Chapter 4]. Meticulous documentation of fluid composition and
volume, insulin administration, vital signs and neurological state
of well-being is essential. These will facilitate the transition to
the appropriate in-patient service, whose task is to understand the
biological impact of fluid rehydration and fluid flux, as well as
hypocapnea, hyperglycemia and cranial perfusion [Chapter 5]. The
current standards of care all but prevent most of the varied
biochemical complications of "appropriate" care for persons with
DKA. However, awareness of these possibilities is crucial [Chapter
6]. Yet, one complication remains unexplained and too often
unpredicted, and it is devastating to the pediatric patient:
cerebral edema. This complication, its prevention and treatment are
discussed [Chapter 6]. Type 2 diabetes mellitus is continuing to
increase in incidence and prevalence among all ages. Once thought
to be "non-ketosis prone" diabetes, now persons undiagnosed or
previously diagnosed do obtain DKA. They, however, have other
unique medical requirements that must be applied to their treatment
[Chapter 3]. Hyperglycemic hyperosmolar state is a complication no
longer limited to adults with diabetes or children with Type 2
diabetes mellitus. While the incidence is fortunately lower than
that of DKA, its outcome is potentially direr. Appreciation of the
unique treatment requirements and guidelines are discussed [Chapter
7]. This monograph provides a comprehensive compendium to those
caring for children of all ages with diabetic ketoacidosis, its
related disorders and associated conditions.
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