mia may predispose the patient to cardiac arrhythmias. Level of consciousness .... book or twitter to educate the lay public and to monitor patients. Until then ...
Tropical Medicine and International Health
doi:10.1111/tmi.12195
volume 18 no 11 pp 1357–1364 november 2013
Review
Diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa? A. N. Murunga and P. M. O. Owira School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Summary
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services. keywords diabetes, insulin, ketoacidosis, children, Africa
Introduction Diabetic ketoacidosis (DKA) is defined by blood glucose concentrations >11.0 mM, venous blood pH
