Endocrine Abstracts

Introduction: Guidance on the management of diabetic ketoacidosis (DKA) has recently been updated in an effort to reduce the risk of complications, in particular, cerebral oedema. However, differences in recommendations for children and adults persist making the care of teenagers with DKA confusing and potentially hazardous.

Aims: To compare the management of DKA in teenage patients in paediatric and adult care settings in the context of the latest national guidelines^1,2.

Methods: A retrospective review of DKA cases aged 14–19 years, admitted with DKA to a teaching hospital between June 2010 and May 2011.

Key findings: Ten cases were reviewed with a median age 15.9 years (range 14.2–18.6). Four patients were cared for by the adult team (age range 17.8–18.6 years) and six patients by the paediatric team (age range 14.2–16.0).

Fluids: All adult patients received fluid boluses (4/4) compared with only one of the paediatric group (1/6). All paediatric patients received potassium in their maintenance fluid from the outset in contrast to only two adult patients (2/4).

Complications: Neuro-observations were recorded in only one of the adult patients (1/4) and 4 of the paediatric patients (4/6). No patients developed cerebral oedema. One paediatric patient developed hyperkalaemia, this resolved without specific treatment. One drug error occurred in each group.

Outcome: Only one patient, belonging to the adult group, required high dependency care. The mean inpatient stay in the adult group was 49 h (range 20–72 h), and in the paediatric group 26.5 h (range 8–40 h).

Summary: This small project highlights noteworthy differences in fluid therapy in adolescent DKA managed by different teams. Some aspects fell below recommended standards in both paediatric and adult care, in particular careful monitoring of neurological status.