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Monitoring
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Bedside glucometer and blood ketones
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Initial work up
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Fever, vomiting or diarrhea; at symptoms/ morning fasting values/ frequent daily
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Continuous glucose monitoring*
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Initial work up; for months or years in more severe, pathological KH
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Prevention
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Dietary
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Complex carbohydrates, protein
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Before sleep only; for every meal
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Meal interval
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Dependent on age, severity and frequency of KH
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Uncooked corn starch
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½–1 (− 2) g/kg, 1–4 × daily
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Long-release corn starch
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Severe, frequent KH
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Continuous gastrostomy tube feeding
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Severe, frequent KH. Night feeding with maltose 1/2–1 g/kg/h; other tube feeding products
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Acute treatment
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Dietary
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Sugar-rich drinks and food
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KH attacks without compromised swallowing. Add complex carbohydrates, eventual protein
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Buccal carbohydrate gel application
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KH attacks with compromised swallowing. 1/2–1 tube, eventually repeated
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Medication
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I.m. glucagon
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Severe KH attacks with unconsciousness. 30–40 mcg/kg, maximal 1 mg. Only if proven efficient and safe at specialist center
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I.v. glucose or dextrose
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Severe KH attack. Ensure PG > 3.9 mmol/L (70 mg/dL). Continue until blood ketones < 0.5 mmol/L
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