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[IPp] Re: Definition of DKA and how to know

Kerri writes:

 <<too many people toss the term DKA around when it really isn't full blown 
DKA. We owe it to any newbies not to do that and be correct with our facts. 
I've looked into this at length and talked to our endo and others. It isn't 
something I'm pulling out of the air, or just my opinion, I can assure you.>>

       Sorry, but you were confusing in your earlier post about what 
comprised DKA--I posted to clarify things for the "newbies" as you call them.

You said :  
 << because pH alone sn't the defining/determining factor. There are other
things (in the blood, and symptoms) that have to occur
together to make the diagnosis. >>  snipped from your post.

Yes, however, the other things are as I posted and are fairly straightforward 
for a parent to asess at home: high bgs, and the presence of ketones.  

What we cannot do at home is a venous blood draw to see if the blood pH is 
outside of the normal range.   A doctor determining if DKA is present or not, 
is not faced with a difficult decision, as you seem to imply, once they have 
those lab results.  

You also said: <<I can't say whether or not your child had DKA as I wasn't 
there. The dr could have been wrong and she could've had mild DKA.>>

Not sure if that was meant for me, because as was clearly posted in my 
message, my daughter was in DKA in August, as determined by the blood work 
showing a pH of 7.15.   Unless perhaps you think the lab report was wrong?

Also your statement : <<f 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. >> 

Well, I have to disagree here.  You do not know the blood pH!!  Claire was 
looking quite sick when I took her to the hospital, but after a bit of a rest 
in the ER, and without ANY treatment, she looked fairly perky.  However, she 
was in DKA.  She is a very strong little girl.  Two hours later  (4 hours 
after arriving at the hospital) the IV line was finally started but was 
removed two hours after that as it was inserted improperly and kept 
occluding.  Doctor thought she might not put another IV line in, if Claire 
could drink enough fluid.  Claire was looking very bright and chipper at this 
point, but later  started vomiting the dark red Crystal Lite she was 
drinking. (Ooh, all that red over her white sweater and the white sheets!!)  
She DID NOT look very sick at all.  IV line was started again at 11 pm, and 
the blood draw the following morning did not show much of an improvement in 
the blood pH. Thus she was still in DKA the following day, by definition of 
what DKA is.   

My point of this : YMMV--everyone's child is unique.  Your child may be very, 
very ill with mild DKA, while mine appears alright even in moderate DKA..  
Mild DKA is treated with insulin, and fluids.  No need for an IV if you can 
drink on your own..   If you treat this way at home and the condition 
improves, you do not know for sure whether you have successfully treated DKA 
or treated and avoided DKA.     

Cerebral edema is a complication of ketoacidosis, almost exclusively a 
condition of childhood.  It can be present at the onset of DKA or develop 
later, usually between 4-12 from the start of treatment.  Thus is not always 
a result of too rapid hydration.   It requires urgent recognition and 
intervention with mannitol.  

While mild DKA is treated with insulin and fluids, if you know it is DKA you 
are probably at the emergency room and have received the blood work results.  
It makes sense that you would stay there for a couple of hours drinking 
fluids and checking that your bgs were coming down.  But if that is all that 
is being done, I for one would much rather be at home with my child.  I don't 
think there are too many of us that like to spend time in the ER, especially 
at full moon time. 

Barbara, Mum of Claire 8
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