Diabetic ketoacidosis in children and infants causes symptoms and effective treatment methods

Diabetic Ketoacidosis (DKA) in Children and Infants is a serious condition that can happen when blood sugar levels rise too high and insulin levels drop too low. It often comes on suddenly and, if not treated quickly, can lead to dangerous complications for the child. That’s why it’s so important for every parent to be aware of the symptoms of DKA, understand what causes it, and know exactly how to act in an emergency.In this Dalily Medical article, we’ll explain everything you need to know about diabetic ketoacidosis in children and infants in a simple and clear way. We’ll also share the most important steps for treatment and prevention based on doctors’ advice and the latest medical guidelines.

What is Diabetic Ketoacidosis (DKA)? Causes and Serious Complications

Diabetic ketoacidosis (DKA) is one of the most dangerous complications that can happen to people with diabetes—especially children. It occurs when the body doesn’t have enough insulin, so it starts breaking down fat for energy instead of sugar. This process produces ketones, which build up in the blood and make it more acidic.

To diagnose DKA, doctors usually look for three key signs:

Presence of ketones in the blood
High blood sugar levels
Acidic blood (low pH level)

Causes of Diabetic Ketoacidosis

DKA can be caused by two main types of insulin deficiency:

1. Absolute insulin deficiency:

This can happen when:

A child is newly diagnosed with type 1 diabetes and hasn’t started treatment yet.
A known diabetic child misses insulin doses or stops taking them for any reason.

2. Relative insulin deficiency:

This occurs during physical stress like infections or surgery. The body releases stress hormones that raise blood sugar levels, and if the insulin isn't enough to balance this rise, the body can go into DKA.

Which Children Are Most at Risk for DKA?

While DKA can affect any child with diabetes, certain children are more vulnerable—especially if they are not receiving proper treatment or are under specific conditions. Here's a breakdown of the most at-risk groups:

???? 1. Children with Type 1 Diabetes:

They are the highest-risk group, particularly in these cases:

Newly diagnosed and not yet receiving treatment.
Missing insulin doses or stopping insulin therapy.
When they’re sick with an infection like the flu or another illness that stresses the body.

???? 2. Children Not Yet Diagnosed with Diabetes:

Sometimes, a child may have type 1 diabetes without anyone knowing. In such cases, DKA can be the first sign that reveals the condition.

???? 3. Children Facing Illness or Physical Stress:

Severe illness, dehydration, or poisoning can trigger DKA—even in children who are already being treated for diabetes.

???? 4. Children Who Are Not Compliant with Treatment:

Especially if:

There are family problems or barriers to regular insulin use.
The child has mental health issues like depression or eating disorders.
The child or parents lack understanding of diabetes and its seriousness.

⚠️ 5. Children with Type 2 Diabetes (Rare Cases):

Although type 2 diabetes is more common in adults, some children can have it too. DKA may occur in these cases if:

The child is severely obese.
There’s a serious infection or illness.
The child has significant insulin resistance.

???? 6. Children Using an Insulin Pump:

If the pump malfunctions or the tubing gets blocked, the body may not receive enough insulin, leading to a rapid onset of DKA.

???? 7. Children Going Through Puberty:

During puberty, hormone levels change, and the body needs more insulin. If insulin doses aren’t adjusted accordingly, the risk of DKA increases.

⚠️ 8. Children taking medications without medical supervision:

Such as corticosteroids or diuretics. Some medications can cause a sudden spike in blood sugar levels, increasing the risk of DKA.

⚠️ 9. Children with cognitive or learning difficulties:

These children may not understand the importance of insulin therapy or may forget to take their medication. They require close monitoring from both family and healthcare providers.

???? Can children recover from diabetic ketoacidosis?

Yes, DKA can be successfully treated, but timely and appropriate medical intervention is crucial.

???? How is it treated?

The core treatment includes intravenous insulin, which works to:

Lower blood sugar levels
Stop the production of ketones
Restore the blood’s pH balance

The child will also receive:

IV fluids to combat dehydration
Electrolytes (like potassium) to help rebalance the body's chemistry

Once the blood sugar drops to a safe level (around 200 mg/dL) and the blood pH normalizes, the doctor can transition the child back to subcutaneous insulin (insulin injections under the skin).

✅ Pro Tip: The sooner the treatment starts, the fewer the complications and the better the chances of full recovery.

???? Epidemiology: How common is DKA in children?

DKA is especially common at the initial diagnosis of type 1 diabetes in children, but its frequency varies by country.

???? What do the numbers say?

In Europe and North America, the percentage of children presenting with DKA at diagnosis ranges from 15% to 70%.
In countries with higher diabetes awareness and better healthcare access, the percentage tends to be lower.
Higher awareness, better education, and economic stability correlate with a lower rate of DKA at the time of diabetes diagnosis.

???? Which children are most likely to present with DKA at first?

Children under age 5
Children whose families struggle to access healthcare due to social or financial issues

❗ Which children are at higher risk of DKA even after diagnosis?

Even after being diagnosed with type 1 diabetes, some children remain at ongoing risk of DKA, with annual rates ranging from 1% to 10%. Key risk factors include:

⚠️ 1. Poor blood sugar control:

Children with uncontrolled diabetes or previous DKA episodes are at greater risk.

⚠️ 2. Adolescent girls:

Hormonal changes during puberty can affect blood sugar levels, increasing insulin needs and DKA risk.

⚠️ 3. Children with mental health issues:

Conditions like depression or eating disorders (e.g., anorexia, bulimia) can interfere with consistent insulin use.

⚠️ 4. Children in unstable home environments:

Situations like parental separation, neglect, or lack of supervision can hinder proper diabetes management.

⚠️ 5. Children refusing insulin:

Whether due to psychological reasons or lack of awareness, refusal to take insulin significantly increases DKA risk.

⚠️ 6. Limited access to healthcare:

Families who can’t easily reach a doctor or lack regular follow-up face higher risk.

⚠️ 7. Children using insulin pumps:

Insulin pumps deliver only rapid-acting insulin, so if the pump fails or becomes blocked, DKA can develop very quickly.

???? Comparison Table: DKA in Type 1 vs Type 2 Diabetes

Factor	Type 1 Diabetes	Type 2 Diabetes
Prevalence	Very common, especially in children	Less common, more in adults
Cause	Absolute insulin deficiency	Relative insulin deficiency + resistance
Onset	Sudden and rapid	Slower and more gradual
Ketones	Very high in blood and urine	Moderate to high
Consciousness	Can deteriorate quickly	Altered state slower to appear
Symptoms	Intense thirst, frequent urination, nausea, vomiting, fatigue	Similar, but milder in some cases
Treatment	IV insulin, fluids, electrolytes	Same, with focus on reducing resistance
Complications	Very serious if untreated	Also serious, often with other illnesses

???? Types of Diabetic Ketoacidosis (DKA) in Children

DKA isn't just one condition—it comes in different levels of severity, based on blood pH and ketone levels. These are the three main categories:

1️⃣ Mild DKA

Often seen at the onset of diabetes or when a dose of insulin is missed.

Blood pH: 7.25 – 7.30
Bicarbonate (HCO₃): 15 – 18 mEq/L

???? Symptoms of Diabetic Ketoacidosis (DKA) by Severity

1. Mild DKA

This is the least severe form and is often discovered early in the disease or when the child forgets a dose of insulin.

Blood pH: 7.25–7.30
Bicarbonate (HCO₃): 15–18 mEq/L

Symptoms:

Intense thirst and frequent urination
Mild dehydration
Mild fatigue
Fruity-smelling breath

2. Moderate DKA

This stage is more serious and requires faster intervention.

Blood pH: 7.00–7.24
Bicarbonate: Less than 15 mEq/L

Symptoms:

Noticeably rapid breathing
Severe fatigue
Moderate dehydration
Nausea or vomiting
Abdominal pain

3. Severe DKA

This is the most dangerous form and requires immediate hospitalization and intensive care.

Blood pH: Less than 7.00
Bicarbonate: Less than 10 mEq/L

Symptoms:

Loss of consciousness or severe confusion
Deep and very rapid breathing (Kussmaul respiration)
Severe dry mouth and skin
Repeated vomiting
Rapid weight loss
Low blood pressure

⚠️ Key Warning Signs of DKA in Children

If you notice any of the following symptoms in a child, seek medical help immediately:

Excessive thirst and frequent urination
Dry mouth and skin
Unusual tiredness or lethargy
Persistent nausea or vomiting
Abdominal pain
Abnormal (deep or fast) breathing
Fruity or acetone-like breath
Confusion or trouble focusing
Noticeable and sudden weight loss

???? Complications of Diabetic Ketoacidosis in Children and How to Prevent It

DKA in children can be extremely dangerous if not treated promptly. Understanding the possible complications can help parents act fast, and more importantly, take steps to prevent DKA from occurring.

⚠️ Major Complications of DKA in Children

1. Severe metabolic acidosis (DKA itself):
When the body lacks insulin, it starts breaking down fat for energy, producing ketones that make the blood acidic. This can cause severe fatigue, coma, or loss of consciousness.

2. Severe dehydration:
Due to frequent urination, the child loses a lot of fluids, which can affect the function of multiple organs.

3. Electrolyte imbalance:
Loss of essential minerals like potassium and sodium can lead to heart problems and nerve dysfunction.

4. Cerebral edema (brain swelling):
A rare but life-threatening condition caused by fluid shifts during aggressive treatment, leading to breathing issues or unconsciousness.

5. Infections:
Children with diabetes have weaker immune systems, making them more prone to infections, which can further worsen DKA.

6. Dangerous blood sugar fluctuations:
Irregular insulin doses or poor management can lead to dangerously high or low blood sugar levels.

???? How is DKA Diagnosed in Children?

1. Clinical Examination:
The doctor will ask about the child's symptoms like extreme thirst, frequent urination, fatigue, rapid breathing, and dry mouth. They will also check pulse, breathing, and consciousness level.

2. Blood Tests:

Blood sugar level (usually above 250 mg/dL)
Blood gas analysis to measure acidity (pH)
Ketone levels in blood or urine
Electrolyte levels (potassium, sodium, chloride)

3. Urine Tests:
To check for glucose and ketones.

4. Additional Tests (if needed):
To assess kidney and liver function.

????️ How to Prevent Diabetic Ketoacidosis (DKA) in Children

1. Stick to the diabetes treatment plan:
Make sure the child receives insulin doses on time and eats healthy meals regularly.

2. Monitor blood sugar regularly:
Use a home glucose meter consistently to avoid sudden spikes or drops in blood sugar levels.

3. Test for ketones when needed:
If the child feels tired, excessively thirsty, or urinates frequently—especially with high blood sugar—test for ketones in urine or blood.

4. Act quickly in case of illness or infection:
Illness increases the risk of DKA, so consult a doctor promptly if the child becomes sick.

5. Educate and raise awareness:
Teach the child and family how to recognize DKA symptoms and understand the importance of fast action.

6. Keep the child well-hydrated:
Encourage regular fluid intake to replace fluids lost through frequent urination.

7. Attend regular doctor visits:
Ongoing medical follow-ups help adjust treatment and monitor the child’s condition.

???? Treatment of Diabetic Ketoacidosis in Children

DKA is a medical emergency in children and must be treated promptly to prevent serious complications. Treatment focuses on correcting dehydration, insulin deficiency, and electrolyte imbalance. Here's a simple breakdown of the treatment steps:

1. IV Fluid Replacement (Rehydration)

Due to excessive fluid loss, the child is given fluids intravenously.

IV fluids help:

Prevent dehydration and restore circulation.
Lower blood sugar and dilute ketones in the blood.
Quickly stabilize the body’s balance.

2. Insulin Administration

Insulin is given continuously through an IV or in scheduled doses.

Insulin functions to:

Help cells absorb glucose.
Gradually reduce blood sugar levels.
Stop ketone production, which causes acidosis.

⚠️ Insulin should never be stopped unless directed by the doctor.

3. Correcting Electrolyte Imbalance

DKA affects electrolyte levels—especially potassium, which may be dangerously low.

Doctors monitor and correct levels of:

Potassium
Sodium
Chloride

⚠️ Potassium is usually given through IV fluids to maintain heart and nerve functions.

4. Close Monitoring

Continuous observation of:

Blood sugar levels
Blood pH (acidity)
Breathing rate
Consciousness level

This ensures treatment is working and helps catch complications early.

5. Treating the Underlying Cause

If DKA was triggered by an infection or illness, that condition is treated alongside DKA.

6. Medical and Psychological Support

Support for the child and family is essential:

Teach how to monitor the condition at home.
Help prevent future DKA episodes.

???? Giving Insulin in DKA Treatment for Children

Insulin is a key step in treating DKA, but it must be given carefully.

⏰ When to Start Insulin?

Start 1–2 hours after IV fluids and potassium have been given.

Why?
Giving insulin too early can raise the risk of cerebral edema (brain swelling), a dangerous complication.

???? How Is It Given?

Insulin is given via IV at a controlled rate (usually 0.05–1 unit/kg/hour).

The child is not switched to subcutaneous insulin (injection under the skin) until they:

Are awake and alert
Can tolerate food and drink
No longer have vomiting or dehydration

???? Can DKA Be Treated at Home?

No. Treating DKA at home is not safe. It is a serious condition that requires hospital care. However, if the symptoms are mild and just beginning, caregivers can take some immediate steps before going to the hospital:

✅ What You Can Do at Home (Temporarily):

Action	Details
Check blood sugar and ketones	If the child is sick or sugar is high, check for ketones in urine or blood.
Offer fluids	Encourage drinking water or non-sugary drinks to prevent dehydration—don’t force fluids if vomiting.
Monitor condition	Check breathing, alertness, and temperature every hour. If worsening, go to the hospital immediately.
Adjust insulin dose	Follow your emergency insulin plan if provided by the doctor. Never give extra insulin without advice.

❌ What Not to Do at Home

Don’t Do	Why
Treat moderate/severe DKA at home	Needs IV fluids, insulin, and hospital-level monitoring.
Ignore symptoms	Delays can lead to coma or life-threatening complications.
Use herbs or home remedies	Can worsen the condition and delay effective treatment.

???? When to Go to the Hospital Immediately

Head to the ER if any of the following happen:

Very high ketones in blood or urine
Vomiting or refusal to drink fluids
Blood sugar over 300 mg/dL with ketones present
Labored or deep breathing
Severe fatigue, drowsiness, or confusion

????‍⚕️ Which Doctor Treats DKA in Children?

Pediatrician:
The primary care doctor who manages general symptoms and begins treatment.
Pediatric Endocrinologist:
A specialist in childhood diabetes and hormonal conditions—monitors treatment and long-term care.
Pediatric Intensivist:
Manages severe DKA cases in the pediatric intensive care unit (PICU).