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You are seeing an 18 month old with 3 days of cough and congestion and 4 hours of tachypnea. On exam, she has diffuse scattered wheezes and mild intercostal retractions. Her vital signs are: temperature of 38.6, HR 160, RR 40, and O2 sat 94% on room air. As part of her fever work-up her urine is dipped, and while there are no signs of UTI, she has glucosuria. Her serum glucose is 160, and her lytes are Na-138, K-4.2, Cl-110, CO2-17.
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October 18, 2023 at 11:37 am
E) Stabilize her respiratory status and follow up her blood sugar status with her inpatient team or PCP if discharged
Stress hyperglycemia is a common finding in critically ill and even moderately ill pediatric patients. Insulin would be indicated in treating diabetic ketoacidosis, which is defined as hyperglycemia > 200-250 and acidemia with pH < 7.30. Ketonuria and ketonemia would also be present.