Pediatric Case Study: Diabetic Ketoacidosis Secondary to New Onset Type I Diabetes Mellitus

KELLI ZENTZ MDI INTERN 2016-2017

Learning Objectives

❖ Have an overall understanding of diabetic

ketoacidosis in a pediatric patient

❖ Understand the role of the dietitian in a pediatric

patient with new onset type I diabetes mellitus

❖ Examine the evidence regarding the interventions

designed to prevent diabetic ketoacidosis in a

pediatric patient

Patient Introduction

❖ 11 month old Native American male

❖ Admitted to St. Vincent Healthcare on September

14, 2016

❖ Discharged on September 23, 2016

❖ Primary diagnosis:

❖Diabetic ketoacidosis secondary to new onset

type I diabetes mellitus

Diabetic Ketoacidosis (DKA)

❖ Occurs when the body produces high levels of ketones

❖ Causes

❖ Illness, problems w/ insulin therapy, physical/emotional trauma, heart attack, alcohol or drug abuse

❖ Signs and symptoms

❖ increased thirst, frequent urination, nausea/vomiting, abd. pain, weakness, fatigue ect…

Type I Diabetes Mellitus

Insulin dependent

Pancreas does not make enough insulin

Causes:

Inherited or genetic factors, self allergy

(autoimmunity), environmental damage

Nutrition Assessment

❖ Client history

❖Per mother of child (moc)

❖Patient exhibited increased thirst, increased

urination, increased hunger, vomiting,

respiratory distress and some weight loss

❖ No family history of diabetes

Nutrition Assessment

❖ Food/nutrition-related history

❖Prior to admission per Moc

❖ Patient consumed 3 meals per day (breakfast, lunch, and dinner) + bottles of similac sensitive formula

❖ Labs 9/14/16

❖Glucose: 372

❖Hemoglobin a1c: 8.3

❖Ketones urine: negative

❖Ph: 7.12

Nutrition Assessment

❖ Anthropometric measurements

❖Weight: 10 kg (22 lbs)= 75th percentile (who boys’

growth chart birth-24 months)

❖ Medications

❖Sub q shots of lantus and humalog: diluted to 10

units/ml

❖Upon discharge: insulin pump therapy 100 units/ml

Insulin Pump Therapy

❖ Delivery of rapid or short acting insulin 24 hrs/d

through a catheter

❖ Insulin doses include:

❖Basal rates

❖Bolus

❖correction

Insulin Pump Therapy in Children and Adolescents

❖ Determine the impact of insulin pump therapy

including quality of life

❖ 100 patients managed with insulin pump therapy, 3-

19 yrs

❖ HbA1C decreased from 8.3 to 7.8

❖ Hypoglycemia decreased from 32.9 to 11.4 per 100

patients

❖ Quality of life measures showed improvement

Nutrition Assessment

❖ Estimated energy needs (kcals): 980 kcal/d (98

kcal/kg RDA)

❖ Estimated protein needs (g):16 g/d (1.6 g/kg rda)

❖ Estimated fluid needs (mL):1000 mL/d (100 ml/kg)

Diagnosis

❖ Unintended weight loss related to physiological

causes increasing nutrient needs related to

prolonged catabolic illness (type I diabetes mellitus)

as evidenced by polyuria, polydipsia, polyphagia,

and increased respiratory rate.

Intervention

❖ Patient will consume 3 meals plus snacks as desired

per day consisting of proteins, carbohydrates and

lipids

❖ Moc will count all carbohydrates that patient

consumes during meals and snacks

❖ Goal: patient’s blood glucose levels remain between

80-200 mg/dl

Monitoring/Evaluation

❖ Food intake: amount and types of food at meals

❖ Labs: electrolyte and glucose profile

❖ Anthropometric measurements: growth patterns,

weight

❖ Nutrition focused physical findings: overall

appearance

Summary

❖ Have a better understanding of diabetic ketoacidosis in a

pediatric patient

❖ Understand current research regarding the quality of life

pediatric patients have on insulin pump therapy

❖ As dietitians, we play a significant role in new onset type I

diabetes mellitus in pediatric patients now and in the future

References

❖ Mcmahon, S. K., Airey, F. L., Marangou, D. A., Mcelwee, K. J., Carne, C. L., Clarey, A. J., . . . Jones, T. W. (2005). Insulin

pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of

life. Diabetic Medicine, 22(1), 92-96. doi:10.1111/j.1464-5491.2004.01359.x

❖ Plotnick, L. P., Clark, L. M., Brancati, F. L., & Erlinger, T. (2003). Safety and Effectiveness of Insulin Pump Therapy in Children

and Adolescents With Type 1 Diabetes. Diabetes Care, 26(4), 1142-1146. doi:10.2337/diacare.26.4.1142

❖ Fox, L. A., Buckloh, L. M., Smith, S. D., Wysocki, T., & Mauras, N. (2005). A Randomized Controlled Trial of Insulin Pump

Therapy in Young Children With Type 1 Diabetes. Diabetes Care, 28(6), 1277-1281. doi:10.2337/diacare.28.6.1277

❖ Hamdy, O., MD PhD. (2017, March 23). Emedicine.medscape.com. Retrieved May 1, 2017, from

http://emedicine.medscape.com/article/118361-overview

❖ Khardori, R., MD PhD FACP. (2017, April 21). Type I Diabetes Mellitus. Retrieved May 1, 2017, from

http://emedicine.medscape.com/article/117739-overview