Introduction: Diabetic ketoacidosis remains the leading cause of morbidity and mortality in children with type 1 diabetes. BSPED guidelines for management of paediatric DKA were revised in 2009.
Methods: We performed a telephone questionnaire of all 13 centres in Scotland who provide inpatient paediatric (<16 years) care, and reviewed their DKA guidelines. These were audited against the 2009 BSPED guidelines. Criteria studied were; method of ketone measurement; maximum percentage of dehydration; maintenance fluids; minimum time on isotonic fluids; commencement of insulin; long acting analogues; end point of DKA management; treatment of cerebral oedema.
Results: Overall, there was 38.5% compliance with BSPED guidelines for these criteria. Eight of 13 centres use blood ketone measurement. Nine of 13 centres use 10% as the maximum dehydration calculated for DKA, three centres use a maximum of 8%. Maintenance fluids are calculated using the BSPED calculation in three centres, and the ISPAD calculation in five centres. Three centres state minimum time on isotonic fluids of 12 h, four state 46 h. Nine of 13 centres delay commencing IV insulin until 12 h after fluid replacement. Ten of 13 centres use BSPED initial doses of insulin, two centres use lower starting doses. Four of 13 centres continue subcutaneous glargine during treatment for DKA. Six of 13 centres use blood ketones as an endpoint of DKA treatment, four centres use a clinical end point. Six of 13 centres recommend hypertonic saline or mannitol as first line for treatment of cerebral oedema.
Conclusion: The changes suggested in the BSPED guidelines have been taken up 38.5% of instances. Improved education is necessary to ensure that all children with DKA receive optimum care. Outcome data is also needed following changes.
09 - 11 Nov 2011
British Society for Paediatric Endocrinology and Diabetes