Immediate Questions

A. What are the vital signs? Does patient have any mental status changes? Children with hyperglycemia due to diabetic ketoacidosis (DKA) can have mental status changes, including coma.

B. Is patient known to have diabetes mellitus (DM)? Ask about current medications (ie, type, route, and dose) and verify most recent doses taken. Obtain information about home glucose monitoring and current illnesses.

C. What is the serum glucose level on laboratory analysis? Serum glucose level provides the most reliable monitoring information. Glucose monitoring strips can be unreliable for many reasons, including user error, expired strips, and improper machine calibration.

D. Is patient spilling glucose in the urine? A simple dipstick test can identify glucose in urine. Once the renal threshold has been reached, glucosuria will develop.

E. Is patient receiving exogenous glucose and, if so, how much? Calculate the glucose infusion rate, which will indicate how many milligrams per kilogram per minute of glucose patient is receiving.

F. Does patient have signs of sepsis or shock? Shock can result from sepsis or trauma. Patients can also develop hyperglycemia postoperatively.

G. Are there signs of uncontrolled, new-onset DM? These signs include polyuria, polydipsia, polyphagia, weight loss, fatigue, and increased infections.

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