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A 2004 statement by the European Society for Paediatric Endocrinology and the Lawson Wilkins Pediatric Endocrine Society (for children) uses slightly different cutoffs, where mild DKA is defined by pH 7.20–7.30 (bicarbonate 10–15 mmol/L), moderate DKA by pH 7.1–7.2 (bicarbonate 5–10) and severe DKA by pH<7.1 (bicarbonate below 5).
The major differential diagnosis is diabetic ketoacidosis (DKA). In contrast to DKA, serum glucose levels in HHS are extremely high, usually greater than 40-50 mmol/L (600 mg/dL). [6] Metabolic acidosis is absent or mild. [6] A temporary state of confusion (delirium) is also more common in HHS than DKA. HHS also tends to affect older people more.
Diabetic ketoacidosis (DKA) is one of the life-threatening severe complications of diabetes that demands immediate attention and intervention. [7] It is considered a medical emergency and can affect both patients with T1D (type 1 diabetes) and T2D (type 2 diabetes), but it is more common in T1D. [ 8 ]
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is a form of hyperventilation , which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration.
Diabetic ketoacidosis (DKA), most typically seen in those with type 1 diabetes, is triggered by the build-up of chemicals called ketones. These are strongly acidic and a build-up can cause the blood to become acidic. [5] When these levels get too high it essentially poisons the body and causes DKA. [6]
The Pediatric Assessment Triangle or PAT is a tool used in emergency medicine to form a general impression of a pediatric patient. [1] In emergency medicine, a general impression is formed the first time the medical professional views the patient, usually within seconds. [ 2 ]
The first PICU in the United States is a topic often debated. Currently, Fuhrman’s Textbook in Pediatric Critical Care lists Pediatric Critical Care Unit at the Children’s Hospital of District of Columbia in Washington, DC, dating back to 1965, as the first pediatric critical care unit in the U.S.A. Medical Director was Dr. Berlin. [6]
Despite guidelines recommending that intensive blood sugar control be based on balancing immediate harms with long-term benefits, many people – for example people with a life expectancy of less than nine years who will not benefit, are over-treated. [103] It is recommended that all people with type 2 diabetes get regular eye examinations. [13]