Alaa AlNofal, MD, MBA, Associate Professor of Pediatrics, University of South Dakota Sanford School of Medicine
Two years ago, I was consulted on a 10-year-old boy who was admitted to the pediatric
intensive care unit for severe diabetic ketoacidosis (DKA) in the context of new onset
type I diabetes mellitus. Two days prior to his admission to the intensive care unit,
the boy walked into an emergency department complaining of abdominal pain, vomiting,
and a sore throat. He was diagnosed with a “throat infection” and was sent home with
an antibiotic prescription. On the day of admission, he was lethargic, weak, severely
dehydrated, and barely able to answer questions. His glucose level was >1400 mg/dL,
his bicarbonate level was 8 mEq/L, his pH was 7.1, and beta-hydroxybutyrate level
was >4.5 mmol/L. Further questioning revealed that he had had polyuria, polydipsia,
and weight loss for the previous 3-4 weeks. He received the appropriate treatment
as outlined in Drs. Cashen’s and Peterson’s article and was discharged home 4 days later after he and his family received proper diabetes
Misdiagnosing this child as having a “throat infection” demonstrates a knowledge gap
that needs to be filled in regard to recognizing and diagnosing DKA. The article by Drs. Cashen and Peterson that is featured in the August issue of Pediatrics
in Review is a perfect example of what we need in order to enhance the knowledge to recognize,
diagnose, and manage DKA. The article is well organized and easy to read. It thoughtfully
outlines a step-by-step approach to treating DKA while citing the supporting evidence.
It provides the basic information that every general practitioner could benefit from
when caring for a child with DKA.
Our efforts to educate healthcare providers, and the public, on signs and symptoms
of diabetes and DKA should not stop here; we have a moral obligation to our communities
to make DKA a rare occurrence in children with diabetes.