This document discusses hypoglycemia in children with diabetes. It defines hypoglycemia and describes its symptoms. Mild hypoglycemia can be treated by the patient, while moderate or severe hypoglycemia requires assistance and may include loss of consciousness or seizures. Management of hypoglycemia involves giving rapid-acting carbohydrates. The document also provides guidance on educating patients and caregivers about hypoglycemia prevention and treatment.

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2. A. Hypoglycemia
B. Persistence Acidosis
C. Hypokalemia
D. Cerebral edema
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3.  Hypoglycemia -glucose level <3.9 mmol/l
(about 70 mg/dl)
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4.  autonomic activation  neuroglycopenia
 Trembling  Difficulty in concentrating
 Rapid heart rate  Irritability
 Palpitations  Blurred double vision
 Sweating  Disturbed colour vision
 Pallor  Difficulty hearing
 Hunger / nausea  Slurred speech
 Dizziness and unsteady gait
 Tiredness
 Nightmares
 Loss of consciousness
 Seizures
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5. i. Mild hypoglycemia-Pt recognizes it &is
able to Tx it.
ii. Moderate hypoglycemia-child / parent is
aware of &Tx with assistance .pt not able to
support himself .
iii. Severe hypoglycemia-when the patient either
loses consciousness or has a convulsion.
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6.  The Pt will have symptoms of moderate or
severe hypoglycemia without the warning
symptoms of mild hypoglycemia coming first.
 Mgt- adjusting target glucose values upwards,
to avoid hypoglycemia for several weeks or
months
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7. I. Feeding the child with rapid-acting CHO food.
-severe symptoms
II. IV glucose (10% glucose drip or 1ml/kg of 25%
dextrose)
III. IV, IM or subcutaneous glucagon (0.25 mg for
small children; 0.5 mg for children up to 40-50
kg).
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8. 1) Teach the child and parents about The
symptoms of hypoglycemia
2) Remind them about what might cause
hypoglycemia &Risk Factor assessment for
hypoglycemia
3) use MedicAlert identification bracelet or
necklacee “I have diabetes”
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9.  Clinically apparent Cerebral edema occurs in
1-2% of children with DKA. It is a serious
complication with a mortality of > 70%. Only
15% recover without permanent damage.
 Typically it takes place 6-10 hours after
initiation of treatment, often following a
period of clinical improvement.
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10. The mechanism of CE is not fully understood,
but many factors have been implicated:
 rapid decline in serum osmolality with
treatment.
 high initial corrected serum Na
concentration.
 high initial serum glucose concentration.
 longer duration of symptoms prior to
initiation of treatment.
 younger age.
 failure of serum Na to raise as serum glucose
falls during treatment.
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11.  Sx of ICP
 deterioration of level of consciousness
 Headache & Vomiting
 Papilledema & pupillary changes
 seizures & posturing
 Incontinence
 Change in vital signs -bradycardia &
respiratory arrest when brain stem herniation
takes place.
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12.  Elevate the head of the bed
 Reduce the rate of fluid administration by 1/3
 Intubation/Hyperventilation
 Give mannitol 0.5-1 g/kg IV over20 minutes
&repeat if there is no initial response in 30’-2hr.
OR
 Hypertonic saline (3%), 5 ml/kg over 30’.
 Cranial CT to R/O IC cause of neurologic
deterioration(thrombosis or haemorrhage)10%.
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