Introduction: In August 2015, the British Society for Paediatric Endocrinology and Diabetes (BSPED) released new guidelines for the management of DKA. These new guidelines recommended a much more conservative approach with fluid management in order to reduce the risk of cerebral oedema.
Aim: Based on local anecdotal evidence, we hypothesized that with the new guidelines, we have had to increase maintenance fluid infusion rates more often and that the children required a longer duration of IV therapy.
Method: We collected data from all paediatric patients who presented with DKA to a large inner city hospital from January 2015 to May 2017. The results are analysed in two groups pre-2015 and 2015 impementation. The two groups were compared for any change in fluid therapy within 8 h, duration of IV therapy, and duration taken to normalise pH (pH >7.3).
Results: A total of 25 children (pre2015- n=10; 2015- n=15) were studied. The groups were comparable for age, sex and frequency of new diagnosis. The mean presenting pH (7.108 vs. 7.119) and bicarbonate was lower in the pre-2015 group. Fluid bolus was administered far less frequently (33.3% vs 60%) since the 2015 guideline. Only one child needed a change in rate of IV fluid therapy, pre 2015. In contrast, 33.3% (5/15) children in the 2015 group needed a change in therapy (two- increase in rate, two- additional fluid bolus and 1 needing both). The new guideline recommended a fluid infusion rate lower by up to 39.9ml/h on average (range 2092.5 ml/h). Interestingly, the mean duration of IV therapy was longer in the pre2015 group (13.5 vs 10.53 hrs). There were no complications in either groups.
Discussion: This audit showed that a higher proportion of children needed a change in their fluid therapy when treated according to the current 2015 paediatric DKA guidelines, compared with the previous guideline. Clinicians should be vigilant to the considerable reduction in infusion rates, especially in those with a higher weight. However, acidosis in this group recovered quicker. Further studies should look at whether the new fluid guidelines have changed time spent in hospital or reduced adverse events.