10-27-2020: Always remember that unsuspected or undiagnosed pregnancy can cause diabetic ketoacidosis. So always include a pregnancy test when appropriate.
Diabetic ketoacidosis occurring at the time of diagnosis of diabetes mellitus is more common in younger children. [6] In the United States, the rate of diabetic ketoacidosis is about 25% at the time of diagnosis. [Emphasis added] from the second reference below.
Reference (1) What follows are excerpts of Pediatric Type 1 Diabetes Mellitus Clinical Presentation Updated: Apr 27, 2017 from emedicine.medscape.com:
Symptoms of ketoacidosis
These symptoms include the following:
Reference (2) What follows are excerpts of Pediatric Diabetic Ketoacidosis Emergency Department Care
Updated: Dec 16, 2015 from emedicine.medscape.com:
Incidence of type 1 diabetes mellitus is 2 per 1000.
The exact incidence of diabetic ketoacidosis is unknown but is estimated to be 4-8 per 1000.
Diabetic ketoacidosis occurring at the time of diagnosis of diabetes mellitus is more common in younger children. [6] In the United States, the rate of diabetic ketoacidosis is about 25% at the time of diagnosis. [Emphasis added]
Prognosis
With current medical therapy, diabetic ketoacidosis has a 2-5% mortality rate. Mortality results from the precipitating underlying cause, which is primarily cerebral edema. Cerebral edema occurs in 0.3-1% of all episodes of diabetic ketoacidosis.
The prognosis is excellent if aggressive fluid and insulin therapy commence in the first few hours of diagnosis.History
Classic symptoms of diabetic ketoacidosis (DKA) are often absent in toddlers. If a patient has known diabetes, obtain a history for compliance with insulin regimens and the name of the patient’s endocrinologist. Classic symptoms of DKA are as follows:
Causes
Diabetic ketoacidosis is the presenting complaint in approximately one fourth of newly diagnosed patients with type 1 diabetes mellitus.
Infection is the most frequent cause of diabetic ketoacidosis, particularly in patients with known diabetes.
Aggressive evaluation for infection is always warranted. Strongly consider empiric antibiotic therapy until cultures return.
Patient has poor compliance with existing insulin regimens.
Patient exhibits underlying endocrine changes of adolescence (thelarche, adrenarche, menarche).
Caregiver’s lack of competence may be a cause.
Pump failure may occur (insulin pumps are increasingly in use).
