Pediatric case study: diabetic ketoacidosis secondary to ... · Learning Objectives Have an overall...
Transcript of Pediatric case study: diabetic ketoacidosis secondary to ... · Learning Objectives Have an overall...
Pediatric Case Study: Diabetic Ketoacidosis Secondary to New Onset Type I Diabetes Mellitus
KELLI ZENTZ MDI INTERN 2016-2017
Learning Objectives
❖ Have an overall understanding of diabetic
ketoacidosis in a pediatric patient
❖ Understand the role of the dietitian in a pediatric
patient with new onset type I diabetes mellitus
❖ Examine the evidence regarding the interventions
designed to prevent diabetic ketoacidosis in a
pediatric patient
Patient Introduction
❖ 11 month old Native American male
❖ Admitted to St. Vincent Healthcare on September
14, 2016
❖ Discharged on September 23, 2016
❖ Primary diagnosis:
❖Diabetic ketoacidosis secondary to new onset
type I diabetes mellitus
Diabetic Ketoacidosis (DKA)
❖ Occurs when the body produces high levels of ketones
❖ Causes
❖ Illness, problems w/ insulin therapy, physical/emotional trauma, heart attack, alcohol or drug abuse
❖ Signs and symptoms
❖ increased thirst, frequent urination, nausea/vomiting, abd. pain, weakness, fatigue ect…
Type I Diabetes Mellitus
Insulin dependent
Pancreas does not make enough insulin
Causes:
Inherited or genetic factors, self allergy
(autoimmunity), environmental damage
Nutrition Assessment
❖ Client history
❖Per mother of child (moc)
❖Patient exhibited increased thirst, increased
urination, increased hunger, vomiting,
respiratory distress and some weight loss
❖ No family history of diabetes
Nutrition Assessment
❖ Food/nutrition-related history
❖Prior to admission per Moc
❖ Patient consumed 3 meals per day (breakfast, lunch, and dinner) + bottles of similac sensitive formula
❖ Labs 9/14/16
❖Glucose: 372
❖Hemoglobin a1c: 8.3
❖Ketones urine: negative
❖Ph: 7.12
Nutrition Assessment
❖ Anthropometric measurements
❖Weight: 10 kg (22 lbs)= 75th percentile (who boys’
growth chart birth-24 months)
❖ Medications
❖Sub q shots of lantus and humalog: diluted to 10
units/ml
❖Upon discharge: insulin pump therapy 100 units/ml
Insulin Pump Therapy
❖ Delivery of rapid or short acting insulin 24 hrs/d
through a catheter
❖ Insulin doses include:
❖Basal rates
❖Bolus
❖correction
Insulin Pump Therapy in Children and Adolescents
❖ Determine the impact of insulin pump therapy
including quality of life
❖ 100 patients managed with insulin pump therapy, 3-
19 yrs
❖ HbA1C decreased from 8.3 to 7.8
❖ Hypoglycemia decreased from 32.9 to 11.4 per 100
patients
❖ Quality of life measures showed improvement
Nutrition Assessment
❖ Estimated energy needs (kcals): 980 kcal/d (98
kcal/kg RDA)
❖ Estimated protein needs (g):16 g/d (1.6 g/kg rda)
❖ Estimated fluid needs (mL):1000 mL/d (100 ml/kg)
Diagnosis
❖ Unintended weight loss related to physiological
causes increasing nutrient needs related to
prolonged catabolic illness (type I diabetes mellitus)
as evidenced by polyuria, polydipsia, polyphagia,
and increased respiratory rate.
Intervention
❖ Patient will consume 3 meals plus snacks as desired
per day consisting of proteins, carbohydrates and
lipids
❖ Moc will count all carbohydrates that patient
consumes during meals and snacks
❖ Goal: patient’s blood glucose levels remain between
80-200 mg/dl
Monitoring/Evaluation
❖ Food intake: amount and types of food at meals
❖ Labs: electrolyte and glucose profile
❖ Anthropometric measurements: growth patterns,
weight
❖ Nutrition focused physical findings: overall
appearance
Summary
❖ Have a better understanding of diabetic ketoacidosis in a
pediatric patient
❖ Understand current research regarding the quality of life
pediatric patients have on insulin pump therapy
❖ As dietitians, we play a significant role in new onset type I
diabetes mellitus in pediatric patients now and in the future
References
❖ Mcmahon, S. K., Airey, F. L., Marangou, D. A., Mcelwee, K. J., Carne, C. L., Clarey, A. J., . . . Jones, T. W. (2005). Insulin
pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of
life. Diabetic Medicine, 22(1), 92-96. doi:10.1111/j.1464-5491.2004.01359.x
❖ Plotnick, L. P., Clark, L. M., Brancati, F. L., & Erlinger, T. (2003). Safety and Effectiveness of Insulin Pump Therapy in Children
and Adolescents With Type 1 Diabetes. Diabetes Care, 26(4), 1142-1146. doi:10.2337/diacare.26.4.1142
❖ Fox, L. A., Buckloh, L. M., Smith, S. D., Wysocki, T., & Mauras, N. (2005). A Randomized Controlled Trial of Insulin Pump
Therapy in Young Children With Type 1 Diabetes. Diabetes Care, 28(6), 1277-1281. doi:10.2337/diacare.28.6.1277
❖ Hamdy, O., MD PhD. (2017, March 23). Emedicine.medscape.com. Retrieved May 1, 2017, from
http://emedicine.medscape.com/article/118361-overview
❖ Khardori, R., MD PhD FACP. (2017, April 21). Type I Diabetes Mellitus. Retrieved May 1, 2017, from
http://emedicine.medscape.com/article/117739-overview