Pediatric Diabetes: Management of Acute Complications in the Emergency Department (Pharmacology CME)

Enlarge Image
Delivery Method:	Online
$99.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: November 2023 (Volume 20, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 11/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

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. This issue provides guidance for recognizing pediatric patients with new-onset diabetes as well as diabetic crises in established patients. The most recent literature is reviewed and an approach to managing emergent diabetic complications in the pediatric patient is provided, with a focus on initial stabilization and management. Key features in treating pediatric patients with hyperglycemic emergencies are discussed, including rapid fluid resuscitation when indicated, initiation of insulin, and addressing complicating comorbidities.

Case Presentations

A 3-year-old previously healthy girl presents to the ED with fatigue and vomiting…

• The girl’s parents tell you she has had increased thirst and appetite over the last 6 weeks but has lost 2 kg since her last check-up.
• She developed a runny nose and cough yesterday and a fever of 101°F, which has resolved. Today, she began vomiting and became fatigued.
• Upon arrival to the ED, the girl is alert, but given her pale and fatigued appearance in triage, she was immediately taken to a room. Her vital signs are: temperature, 37°C; heart rate, 132 beats/min; blood pressure, 70/40 mm Hg; respiratory rate, 31 breaths/min; and oxygen saturation, 100% on room air. Her examination is notable for pallor and ill appearance. She has dry and cracked lips and is breathing fast, with clear lungs. She has epigastric tenderness, but otherwise her abdominal examination is normal.
• You can tell this patient is ill, and her history is concerning. What treatment will you initiate to immediately address her shock?

A 13-year-old boy with known type 2 diabetes mellitus and cough for the past 3 days presents to the ED with a glucose level of >600 mg/dL at his pediatrician’s office during his well-adolescent check…

• The boy was diagnosed 1 year ago and has been using diet and exercise to manage his diabetes. He has felt a little more tired this week and also says he thinks his vision is a little blurry, but he has not had a recent eye examination.
• Upon arrival to the ED, he is well-appearing and in no distress. He is eating a bag of spicy chips in the room. His examination is notable for obesity and acanthosis nigricans circumferentially on his neck. His vital signs are normal for his age except for a heart rate of 110 beats/min and blood pressure of 131/87 mm Hg.
• As you assess this patient, you think about his elevated glucose at the pediatrician’s office. You are surprised he is so well-appearing, but you are worried about progression of his illness. How should you manage this patient?

A 17-year-old girl with type 1 diabetes mellitus presents to the ED for altered mental status…

• She is here with her mother who found her daughter on the floor in her room after hearing a “thud.” The girl was not responsive to voice, but woke up in a drowsy state when her mother shook her vigorously. She continued to fall asleep and had to be repeatedly stimulated. The mother called 911 and then brought her daughter by private vehicle to the ED, which is only 5 minutes from their house.
• Upon arrival, the patient is minimally responsive, with a Glasgow Coma Scale score of 8. She has no signs of visible trauma, but on rapid examination, you notice that she has an insulin pump. You check a point-of-care glucose level, which is 29 mg/dL. You rapidly administer the adult dose of dextrose.
• How does the presence of an insulin pump change your initial differential diagnosis prior to obtaining laboratory information? In addition to treating her low glucose, what additional steps are necessary to keep this patient safe?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.