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RE: [IP] Ketones...(poll)

We've had large and moderate ketones a few times but have never
needed to go to the ER or dr for them yet *knock wood* (we do let
the dr know though. He's always asked us to let him know when
there's a problem even if we don't think we need his help.) Going
to the hospital is usually not necessary - just depends on each
situation. We'd definitely go to the ER or dr asap if we could
not get the ketones to go away after aggressive management or if
the overall condition worsened. They are usually gone by 4-6hrs
though. Here is our plan: 

For high bgs and ketones we give extra insulin, usually humalog
but sometimes regular (how much depends on the child's total
daily dose and the amount of ketones - less for trace/small, more
for moderate/large) every 2-3hrs until the ketones are gone, and
lots of clear, non-caloric (ie: no carbs) liquids to help flush
out the ketones. The extra insulin is *essential* to shut off the
ketone production. The more quickly you act and the more
aggressive you are in the beginning, the less likely you are to
have serious trouble later (as we all know, high bgs and ketones
can escalate to DKA very rapidly.) Once the bg gets below 200 we
then allow caloric fluids and foods.  

For low or normal bgs and ketones we also give extra insulin BUT
we give caloric/carb containing fluids to keep the bg from
dropping too low. Again, the extra insulin is necessary to shut
off the ketones so to counteract any lows from all the extra
insulin you need glucose. 

In cases where the child just absolutely CANNOT keep anything
down after so many attempts, no matter what you do, or the
condition worsens despite all attempts, then I would go to the ER
for rehydration, etc. DKA is just too dangerous to mess with. Our
worst incident with ketones was when our daughter had severe
vomiting and diarrhea (from a tummy bug - we all had it) and
moderate/large ketones. The dr told me that as long as she got X
amount of fluid per hour she would be all right and would not
dehydrate (he gave me a formula to determine exactly how much per
hour she needed.) So we just made sure she got at least that much
fluid every hour and checked her bgs and ketones very frequently.
Her ketones responded very well and she was able to keep those
frequent, *tiny* amounts of fluid down (sipping), just not a lot
of fluid all at once. So we were able to keep her at home. 

Hope this helps! (And I hope I haven't forgotten anything...I'm
being distracted by little ones!) :)  

Take care, Kerri, alulitsuti (mother of many children) & the
little guy due 3/10/01 
"There is a special magic and holiness about the girl and woman.
They are the bringers of life to the people, and the teachers of
the little children." - Sweet Medicine, Cheyenne
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