DKA MANAGEMENT IN PAEDIATRICS

DKA Management Plan – Rhazez AI

Patient: [Name not provided] Age: 6 years Weight: [Additional data required: Weight in kg]

Diagnosis of DKA: Available data does not meet the diagnostic criteria for Diabetic Ketoacidosis (DKA):

• No evidence of hyperglycaemia (blood sugar not provided)
• No acid-base status (pH, HCO₃, pCO₂ not provided)
• No ketone measurement provided Conclusion: DKA is NOT diagnosed in this case. Clinical features and laboratory findings are instead consistent with nephrotic syndrome.

Severity Classification: Not applicable: DKA is not present.

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Structured Medical Note (Based on Provided Data)

Initial Assessment

• Marked peri-orbital and lower limb oedema, most evident in mornings
• Heavy proteinuria (>3.5 g/day)
• Hypoalbuminaemia (serum albumin 20 g/L)
• Hyperlipidaemia
• Normal renal function
• Normotensive

Impression: Nephrotic syndrome (likely minimal change disease), newly diagnosed.

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Emergency Management Plan

Initial Stabilization (ABCDE):

• Airway, Breathing, Circulation: Assess for signs of respiratory distress or shock (not reported here, but essential in severe oedema or rapid progression)
• Disability: Check mental status, ensure no hypovolaemia or shock
• Exposure: Evaluate for infections, skin changes, scrotal/vulval oedema

Fluid Management:

• Restrict fluids to maintenance (insensible + urine output), as there is no hypovolaemic shock or azotaemia
• Monitor for signs of hypovolaemia (tachycardia, hypotension, poor perfusion)

Diuretics:

• Only if there is significant fluid overload, respiratory distress, or severe oedema and no hypovolaemia (not immediate in new pediatric nephrotic syndrome)

Prevention of Complications:

• Monitor for infection (spontaneous bacterial peritonitis, cellulitis, pneumonia)
• Start prophylactic penicillin if indicated per institutional protocol
• Provide pneumococcal and influenza vaccination as per guideline

Thromboembolism Risk:

• Assess for signs of DVT—rare at onset, but maintain high vigilance

Nutritional Support:

• High-calorie, normal protein diet (no need for protein restriction in children without azotaemia)

Steroids:

• Initiate prednisolone therapy as per pediatric nephrotic syndrome guideline (typically 2 mg/kg/day in divided doses, max 60 mg/day), but confirm diagnosis with nephrology team

Monitoring:

• Daily weight, strict input/output charting
• Blood pressure twice daily
• Daily serum albumin, creatinine, electrolytes until stable
• Urine protein/creatinine ratio or daily protein dipstick monitoring

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Safety Safeguards:

• Monitor for hypovolaemia before considering diuretic or albumin bolus
• Correct any hypovolaemic shock with 20 mL/kg isotonic saline bolus
• Assess for infection on every review
• Avoid unnecessary fluid overload
• Be cautious with albumin infusion: only for severe symptomatic hypovolaemia unresponsive to fluid restriction and diuretic therapy

Red Flags (Immediate Escalation):

• Hypovolaemic shock: tachycardia, delayed capillary refill, hypotension
• Sudden severe abdominal pain (suspect peritonitis)
• Sudden headache or neurological changes (suspect thrombosis)
• Respiratory distress (pulmonary oedema or infection)
• Oliguria (<1 mL/kg/hr), rising creatinine

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Additional data required:

• Weight (for dose calculation)
• Any evidence of infection, shock, or respiratory compromise

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This is a clinical decision-support tool and does not replace physician judgment.

References:

1. EDNephroticSyndromeGuideline.pdf
2. KDIGOClinicalPracticeGuidelineforGlomerulonephritis.pdf
3. BAPNPediatricNephroticSyndrome2021.pdf