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Emmy was admitted to hospital last week, ended up in DKA...

Discussion in 'Parents of Children with Type 1' started by linda, Dec 18, 2010.

  1. linda

    linda Approved members

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    Hi all-Last week we had a terrible scary couple of days, Em had a sinus infection and started a few high numbers Mon-Tue, Tues after school we went to see Regular Pediatrician, who said it looked liked a sinus infection and we figured as much with the highs, (hi 200's)......by Tues late pm em had Large keytones and hi blood sugar....many things learned in hind sight....but now im looking for any info of others who have had symptoms leading to, or effects after, DKA. At 16, dxd @ 10, we have been down many roads with D and Em & I, and seem to be coming out on top. When Em had called from school, and was 300, I asked her to change out insulin and sight, etc. At the time of correcting the blood sugar and re checking ktones every 2 hours and calling ped endo with results. This went on until around midnight when Em became nausious and began heaving, the last request I remember from the ped endo was to re check and call back 2 hours, I disagreed at this point and said to alert the ER we were coming in....We were seen and admitted to the regular ped floor, where an IV was started,blood was drawn (which showed at that time as per attending physician, no DKA) i knew was "fluids"...as it turned out, we did not know it was not insulin, and she continued to spiral down and suffer, nausia discomfort cramps, i had to demand attention and further testing did show DKA at this point Em was moved to PICU and attented to by an intensivist, and electrolytes and insulin were ran and monitered closely for the next 20+ hours.
     
  2. C6H12O6

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    It is unusual to run IV insulin for anything but DKA and Hyperosmolar Nonketotic Syndrome. But IV insulin is usually mixed in a small 100 ml bag which is labeled with a bright orange sticker.

    Was she still getting insulin through her pump before she went into DKA ?

    The NaCl she was getting was probably in a 1 litre bag. It is always a good idea to read the names of the solutions and the rates they are running at. If they ever run potassium ask the doc / nurses what the hourly rate ordered is and make sure that is what it is running at – (IV potassium is a high alert med and is often used in DKA treatment)
     
    Last edited: Dec 18, 2010
  3. joy orz

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    So sorry. That's scary. Ava had an awful virus that caused ketones we couldn't clear, but her labs showed no DKA. She was in for four days. Not fun.

    Do they know why she went into dka so quickly?
     
  4. joy orz

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    Were you NOT giving insulin through her pump?

    Even though Ava's numbers were high and the ketones didn't clear, we administered her doses through her pump with the nurse watching. Dad or I always gave the bolus.
     
  5. Jordansmom

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    Our Children's hospital ER policy is to take their pump away.:mad: And then they're often not in any hurry to start iv insulin. I have known more than one child whose DKA was caused by the ER doc.

    Linda, sorry to hear about your rough week. I like to pretend our teens are a lot less likely to go downhill so quickly.:(
     
  6. joy orz

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    What on earth for unless there's a pump site infection? That makes no sense.

    Our children's made us do a set change with a nurse using their insulin to make sure all was fresh, but they never even touched her pump.

    Looking back, I wish they were more aggressive with the correction factor to clear the ketones. She was getting a dextrose drip because she couldn't keep food down, and we needed carbs to clear the ketones. She really ran high in the threes the two days she was on dextrose, so the ketones would go down, then shoot up again. But all was well in the long run.

    Did your endo give any orders?
     
  7. Jordansmom

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    The ER doc's want "control" over the insulin dosing. I know its nuts. I know a mom who went there with vomiting and severe lows, moderate ketones. They took off her child's pod and threw it in the trash, then left them to spend hrs and hrs waiting in an exam room and when mom begged them to get some insulin started, the Dr. replied "Why are you being so ridiculous? If we haven't given her any food, she doesn't need any insulin!" 5 hrs later she ended up super high, with large ketones, in DKA, in PICU. Then the hospital lawyers paid her a visit.

    Her endo had sent her in and she kept begging the Er Dr. to call him. But they never did. Its not the only nightmare experience in that ER. I will never go there.
     
  8. Rcj176

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    OMG such horror stories...that is really scary!
    We haven't experienced DKA with any of us. I am so glad your daughter is out of the hospital and on the mend...
     
  9. cindyrn6617

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    So sorry you guys have had to go through this. Ryan has been hospitalized once due to Nausea/Vomiting with large ketones. The ER doc started an IV and regular insulin right away and was able to start bringing him down. We'd tried everything we could at home. He did spend one night in the hospital on a regular peds floor. Not fun for our kids or us parents.
     
  10. GaPeach

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    So sorry that you had this experience. I hope she is well on the road to recovery.
     
  11. Barbzzz

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    Linda, I'm so sorry. Sounds like a true nightmare. Prayers that Em begins healing fast.
     
  12. linda

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    Thank you so much. This is the info I am looking for to better understand the treatment. I also want Em as armed with info as possible as we get closer to the road to college and independance.;)
     
  13. linda

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    Thanks!!! She is complaining of that acid feeling in her tummy still, and I want to know if others after experincing this felt the same for a prolonged period of time?
     
  14. linda

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    She was "getting" insulin from her pump which the attending when she brought in, decided would be fine, but in hindsight, how could it have been if she had large keytones for many hours before??? I trusted there knowledge but am very guilty I did not know enough to challenge or ask here....
     
  15. linda

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    So without going into DKA, what were the 4 days needed for? To get electrolytes right? Was she eating?

    I did not get answers to many questions, the things i heard which i tried to disect later was the Ped Endo saying she would not have relied on the same "numbers" the ER attending did at the time of the DKA test??? So I believe there is somthing here to learn more about "numbers" or "levels"
     
  16. linda

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    Yes she was getting her regular rate of basel, but do you mean were we corecting?? I knew they were in touch with our ped endo, and we were doing what we were told. They seemed to be assured the fluids would help the dehydration and the keytones would clear, her sugars were not crazy high in the ER
     
  17. linda

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    Thank you, I have a great respect for all doctors, i just want to understand what could have been prevented with my own knowledge and education for all moving forward. I did the same with her seizure.
     
  18. ehacker

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    linda, which hospital in jersey did you take her to? i have alot of family up there and been doing research on trying to find a decent hospital for aeden when we are visting and possibly mving back up there. most of the people i have talked to up there have told me that if an issue comes up and i am able to to take him to CHOPS in philly but i hate the idea of driving so far when im cncerned fr his health... aeden was just in hospital for DKA last week and i noticed that they wnat to be in control but they do not really know that much about D...they kept asking me well how is this usually resolved...instead of calling an endo they tried doing it on their own until I called my endo and she called them and said send him to PICU with insulin. I felt so lost and out of control but my endo said if ever im at er and dont feel comfortable with how they are handling my DS to call her directly and she will either call er or come to er. i would talk to your endo see if they would do that for you as well so you dont have to go thru the torture that is an er, i know everytime we are at an er with DS i end up wanting to hit a few of the docs and nurses.....good uck and hope Em is feeling better!!! that GI bug is nasty we had it in our house around thanksgiving...
     
  19. Flutterby

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    The policy here is that Pumps are taken off and Regular insulin given.. her endo says its because they can match the regular easily with the dextrose in the IV... They, however, didn't do this with Kaylee and she ended up in DKA (they, did nothing ).. she's only been admitted once.. all other times, in the ER for various things she's kept her pump.. they won't touch it unless she's admitted.
     
  20. MrsBadshoe

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    That is my hospital's "policy" also but I refuse to follow the "policy". I state Regular is completely different insulin from the humilog my children are on and I can control and understand their insulin needs on humilog and don't with Regular. It has ruffled some feathers but I stand my ground and they usually back down. I'm open with Blood sugar readings and when and how much insulin I'm giving but I refuse to rely on them. Most doctors have absolutely no idea who to deal with a Type 1 patient.
     

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