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DKA Management Guidelines
Pediatric DKA guidelines are different
than adult DKA guidelines.
Pediatric DKA is a life-threatening
condition that can occur in children and
teens with type 1 or type 2 diabetes. The
management in pediatrics differs than
that for adults, largely because children
can develop a complication called
cerebral edema.
As part of the NLdkaP, new guidelines
were produced by specialists at the
Janeway Child Health Care Centre that
include a clinical protocol as a poster, a
binder with the latest information, and
clinical pearls for emergency room crash
carts. These DKA management toolkits
will be made available to all emergency
rooms across NL.
Janeway Pediatric
Research Unit
Janeway Hostel, 4th Floor
300 Prince Phillip Dr
St. John’s, NL
A1B 3V6
Phone: 709 777 2933
Fax: 709 777 2965
www.med.mun.ca/JPRU
Funded by Public
Health Agency of
Canada
newfoundland
and labrador
DKA project
(NLdkaP)
2013
Our blood and immune systems are absolutely
blood and
vital organs. On a daily basis, a healthy bone
immune
marrow will produce trillions of new blood cells.
system can
Blood flow is essential for life. Our blood is a very
be extremely
complex
fluid
which
contains
cellular
particles
Posters:
floating in a liquid medium called plasma. The
As a way of informing health care professionals, educators and
cellular components include red blood cells,
theblood
general
public
about the
signsisand
white
cells
and platelets.
Plasma
an symptoms of diabetes
in
children,
a
poster
campaign
was
undertaken
which involved
extraordinarily complex fluid which contains
sending
to all
familyatdoctors’
proteins
vitalposters
for healthy
clotting
times of offices, public health
offices,
schools. clotting
Early detection of T1DM has
injury,
vital pharmacies
for preventionand
of abnormal
and
vital shown
for fighting
infections
and developing
been
to reduce
episodes
of DKA.
an immune response to poisons. Healthy
platelets and white blood cells are essential for
variable.
good health.
There are
some types of
In the
industrialized
chronic
world, acute
leukemia and myelodysplasia which progress
Calenders:
leukemia,
very slowly
are JPRU
compatible
with assistants
a very
As part of the DKA project,
twoand
of the
research
went
atovery
long
life
span.
These
conditions
require
close
the Canadian Diabetes Association Camp Douwanna in
July
aggressive
but do not require
active
therapy. At
2012. Activities with monitoring
the camp participants
included
education
and
cancer of
the opposite end of the spectrum, some types of
DKA prevention. Artwork was produced by the children and teens
the blood,
cancers of the blood and immune system are very
that
to developand
a calendar.
The beautiful
artwork
is thewas then used aggressive
require immediate
hospitalization
was displayed in the
calendar,
along
with
diabetes
educational
and sometimes intensive care. Examples include
tips of the month. leukemia,
The calendar
has been
distributedlymphoma
to families
lymphoma
(non-Hodgkin’s
and Hodgkin’s
lymphoma),
and health care professionals
across
NL. multiple myeloma,
commonest type of
myeloproliferative disorders, myelodysplastic
cancer to affect babies and children.
disorders and lymphoproliferative disorders.
Lymphoma, a cancer of the immune system is
the third commonest childhood cancer. In adults,
Research:
cancer
of the blood and immune system make
part20ofper
thecent
NLdkaP
researchThey
studies
upAs
about
of all cancers.
occurhave been
most
frequently
patients
than
60 years and
presented
atinlocal
and greater
national
conferences
of submitted
age.
for publication. One project was a
DKA Prevention campaign
qualitative study focusing on the needs of families
At dealing
the Health
Sciences
Centre
in St. John’s
with
childhood
diabetes,
andathe second
majority
of
patients
who
need
to
be
admitted
was a review of all cases admitted to the Janeway
t hospital for chemotherapy or for stem cell
Hospital from 2008-2011. Ongoing research will
transplantation are patients who have an
look at whether
admissions of DKA
underlying
cancer ofthe
thenumber
blood orof
immune
changes
(hopefully
decrease)
after
the project is
system. In addition, our patients may frequently
becompleted.
hospitalized for long periods of time,
sometimes for many months. Cancers of the
Atherosclerosis, sometimes called hardening of
the arteries, is a very prevalent health problem.
Platelets and white blood cells are very involved
in the progression of this disease causing
damage to the lining of our blood vessels. Heart
DKA Prevention
toolkits
Innovative
new
tool
for
families
attacks,
stroke and
arterial
clots
in the
legs, are
withtriggered
diabetes.
often
by abnormal blood clotting
related to activation of platelets and white blood
cells.
In addition,
abnormal clotting
in the nurse
veins
Designed
and developed
by diabetes
in
the
legs
can
cause
deep
venous
thrombosis
educator, Donna Hagerty, DKA prevention
and
pulmonary
embolism.
toolkits
have been
made available to families
with a child with diabetes. Included in the
As many as 10,000 individuals in our province
kit are insulin syringes to be used for giving
are taking oral anticoagulant therapy either to
back-upblood
insulin
doses
needed,inketone
prevent
clots
fromifoccurring
patients
strips,
and
instructions
for
to follow if
who are at high risk for stroke,parents
or to prevent
their child
has in
high
blood
sugars.
further
clotting
patients
who
have already
experienced a blood clot. Thrombosis, the term
Health
Care Professional
Training
used
to describe
a pathological blood
clot is the
most common medical complication of cancer
therapy
is aproject,
frequentmembers
cause of concern
As part and
of the
of the for
patients
with
diabetes
mellitus,
obesity,
NLdkaP Team visited hospitals acrossinactivity,
NL and
surgery,
lungprofessionals
failure, inflammatory
met withcardiac
healthorcare
through
bowel disease and other forms of liver and
medical grand rounds. Participants were
kidney disease. The risk of blood clotting
taught about
early detection
diabetes
in
increases
significantly
with everyof
decade
of life.
children, management and prevention of
DKA. Also coming soon is a web-based online course developed for family physicians
and pediatricians on the management
There
is high DKA
risk ofwhich
clotting
newborn
babies
of pediatric
willinbe
available
especially
premature
babies
and
these
patients
nationally through MD-CME.
also have a high risk of bleeding. There is a very