Sugar and Spice . . . Not Always Nice

The case of a tachypneic 8-year-old exemplifies the diversity of etiologies for tachypnea and is a good reminder to avoid conformation bias given a patient’s history. In this case, the child has new onset diabetes and is in diabetic ketoacidosis (DKA). DKA is due to a deranged metabolism given the lack of insulin, leading to hyperglycemia, ketosis, and acidosis as well as dehydration. The chapter highlights the treatment including diligent rehydration and correction of acidosis. This is accomplished by restoring typical metabolic pathways with insulin all while closely monitoring and correcting changes in glucose and electrolytes. Finally, clinical symptoms are monitored closely to avoid pitfalls, which can include altered metal status, respiratory failure, cerebral edema, coma, and death.