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Re: [IPp] Mary's visit to the ER, DK and DKA

My daughter only had mild DKA (as defined by the level
of acidosis) at dx and was so sick she couldn't even
walk. I had to carry her to the ER (she was 6 and I was
9mos pg at the time). She also had a fruity odor on the
breath which is another indicator (the type of ketones
involved in DKA are exhaled via the lungs). Believe me,
you'll know if it has become DKA! I guess you would
have to see both to know the difference but I hope none
of you ever have to. What we typically see at home is
more of a pre-DKA state that without quick and
aggressive action can quickly turn into DKA. Our endo
told me that most people nowadays have never seen DKA
and that even 70-80% of new dx are not in DKA. My
suggestion is that as soon as you see the ketones
forming, be very diligent and aggressive about giving
extra insulin, hydration, and frequent bg and ketone
checks. DKA happens when the DK hasn't been dealt with
in a timely matter.

I want to clarify the thing about vomiting. That
doesn't mean it is DKA. The ketones will give you a
stomach ache, make you feel nauseous and downright bad,
and even make you vomit. Yes, they can appear very sick
but with DKA (even mild) they are much, much sicker.
What makes it DKA is the presence of acidosis, the
degree of which determines if it is mild, moderate, or
severe. Acidic blood is incompatible with life. Your
daughter was probably teetering very close to DKA. Your
dr probably didn't think it was DKA because pH alone
isn't the defining/determining factor. There are other
things (in the blood, and symptoms) that have to occur
together to make the diagnosis. DKA typically takes
days to turn around whereas what we treat at home
typically takes hours.

If you notice ketones and high bgs and the child is
feeling very sick (and even vomits), and you treat it
aggressively and you see it start to turn around within
a few hours, it isn't DKA. But if, after a few hours it
doesn't seem to be turning around and is maybe seeming
worse than before, I'd say it is probably getting more
serious and needs to be checked out. But you'll likely
see it turning around before that point. Any time there
is repeated vomiting (ie: they can't hold anything
down) with the high bgs and ketones, it should be
checked out. I wouldn't chance it.

Take care, Kerri
"I've seen and met angels wearing the disguise of
ordinary people leading ordinary lives, filled with
love, compassion, forgiveness, and sacrifice." - Tracy
Chapman [Heaven's Here on Earth, 1994]

Barbara said:
If it is "only" mild DKA, can we successfully and
safely treat at home with
hydration and insulin?
than one hour later, when I was about to check if bgs
were coming down, she
threw up the water.  So I knew it was now DKA (mother's
Kerri has written that her daughter has had DK a couple
of times and she
has treated it at home herself.  But how do you know it
was only DK?
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