ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2014) 36 P37 | DOI: 10.1530/endoabs.36.P37

Management of paediatric diabetic ketoacidosis: are we doing it right?

Manisha Ramphul & Babita Khetriwal

East and North Hertfordshire NHS Trust, Stevenage, UK.

Introduction: Diabetic ketoacidosis (DKA) is a medical emergency, requiring careful fluid management and insulin administration. The guidelines published by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in 2009 aim to standardise the approach to the management of paediatric DKA across NHS hospitals. Our aim was to report our experience in managing DKA in children in a district general hospital setting.

Method: Retrospective case review of 19 cases of paediatric DKA (patients aged <19 years) presenting to a district general hospital between January 2012 and December 2012.

Results: The median age of presentation was 15 years (interquartile range 11.5–16.5 years). The history and general examination findings were adequately documented for all patients assessed. Blood glucose, ketones and pH were measured in all children. The weight was only documented in 12 patients (63%). The hydration status was documented in seven children (36%) only. The timing of insulin was appropriate in 16 patients (84%). Two children (10%) received fluid boluses inappropriately.

Once treatment was initiated, blood tests were monitored as per the BPSED protocol in 13 patients (68%). The average length of stay in hospital was 3.5 days. All patients and their families received a discharge planning meeting and further education.

Prior to the introduction of the integrated care pathway for paediatric DKA (DKA ICP) in our trust, doctors were trained to apply it into their practice. Despite this, the DKA ICP was only used in three patients in our study group (16%).

Conclusion: The management of DKA is still suboptimal despite robust guidelines which are in place. Children with diabetes commonly present to their local hospitals in emergencies such as DKA. Hence we believe that paediatric trainees nationwide should receive further interactive education on the management of DKA. The use of the DKA ICP, devised to reduce errors in fluid calculations, should be encouraged across all NHS trusts.

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