Diabetic Ketoacidosis (DKA) occurs when there is profound insulin deficiency. It frequently occurs at diagnosis and also in children and youth with diabetes if insulin is omitted, or if insufficient insulin is given at times of acute illness.
DKA results in vomiting, abdominal pain, flushed cheeks, acetone (sweet) smell on breath and dehydration with continued polyuria (excessive urination). Breathing at first is rapid and shallow and later deep sighing respirations (Kussmaul breathing). The level of consciousness decreases and coma and death can ensue.
DKA is a medical emergency and treatment should be initiated at the healthcare site of first contact. The child/youth should be transferred as soon as possible to the best available site of care with diabetes experience.
It is quite likely that some children and youth in developing countries, presenting for the first time in ketoacidosis, die undiagnosed. The symptoms and clinical findings they present with may be diagnosed as more common illnesses such as pneumonia, gastroenteritis, malaria or typhoid. Also, even when the correct diagnosis is made, it is sometimes very late and the child/youth can die or suffer permanent cerebral damage.
This problem has been known for some years, and prompted education campaigns. A project using posters and targeting the community was effective in Parma, Italy, and similar programs have been instituted in South Africa and Australia. Various posters have been used depending on the culture and the target group for education. In 2009, IDF developed a 4-icon poster (frequent urination, weight loss, lack of energy, excessive thirst). The South African paediatric endocrinologists added a fifth icon of bed-wetting.
The Life for a Child Programme has introduced a 6-icon poster - the 6th icon depicting the later stages of DKA - and invited countries supported by the Programme to participate. The campaign was developed to alert health professionals to the signs and symptoms of diabetes in order to make a swift diagnosis and provide appropriate treatment to save lives - championing the vision that no child should die of diabetes.
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