The first priority in the treatment of diabetic ketoacidosis, as in the treatment of any life-threatening illness, is to protect and maintain the airway. If the childs level of consciousness is impaired, a nasogastric tube should be inserted immediately, aspirated and left on free drainage. An oral airway may also be necessary. If respiration is depressed, or there is accompanying respiratory pathology, intubation and ventilation may be required; if in doubt, this is the safest option. Tissue perfusion may be poor and, at least until the first arterial blood gas results are known, supplemental oxygen is generally administered by facemask.
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