Children with diabetes mellitus are at high risk for acute life-threatening complications of their chronic disease. Identification and management of these emergencies can be complex and challenging.
Our recent issue Pediatric Diabetes: Management of Acute Complications in the Emergency Department provides guidance for recognizing pediatric patients with new-onset diabetes as well as diabetic crises in established patients.
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Here are a few key points:
- When evaluating ill children with suspicion for glucose abnormalities in the ED, history over the prior few months is critical. Questions may need to be tailored towards children, for example, asking about clothing fitting rather than “Have they lost weight?”
- Ill children decompensate quickly and need expedient and aggressive fluid resuscitation. Children with HHS are usually moderately to severely dehydrated. They may be hypertensive despite being very dehydrated.
- Children presenting with hyperglycemic crises may have an unknown primary trigger that may complicate the clinical picture. It is critical to consider an additional pathology, such as appendicitis, ovarian/testicular torsion, thyroid disease, or myocarditis, among others.
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