Background: Diabetic ketoacidosis (DKA) can have significant morbidity and mortality in children and young people (CYP). Its management is very well standardised, based on National Guidance (National Institute of Clinical Excellence NICE). In the UK, CYP DKA Guidelines have been reviewed in 2015 in order to reduce the risks of cerebral oedema. There have been concerns that the new recommended fluid management has the potential to increase the risk of acute kidney injury (AKI) or other complications due to significantly reduced fluid management volumes. In our Trust, the 1618 year olds are managed by adult physicians but based on CYP guidelines. We wanted to review the practice in our hospital and to establish our compliance and any deviations from the guidelines and if there are any significant complications in our patients.
Methods: We looked at the notes, discharge letters and lab reports.
Results: Over 12 months (October 2017September 2018) we had a total of 19 episodes of DKA in 019 year old children. 3 episodes were of severe and 16 of mild/moderate DKA. 12 patients received fluid boluses. In 15 cases the ongoing fluid prescription was correct. In all patients insulin was started at least 1 hour after the initial fluids were given. 8/19 (42%) of our DKA episodes occurred in patients with known Type 1 Diabetes Melitus. The guideline was not appropriately used in 8/9 of over 16 year old episodes and 2/11 under 16 year old episodes. 12/19 (63%) received fluid boluses. 2 patients with altered Glasgow Coma Scale (GCS-14/15) received fluid boluses. 2/18 patients were in mild AKI at presentation and 1 was unknown.
Conclusions: In our cohort the majority of patients received fluid boluses, despite this not being the recommended measure on the current guideline. DKA still occurs in patients with known diabetes. Fluid management in DKA still remains a topic of some controversy. The British Society of Paediatric Endocrinology (BSPED) is currently reviewing the fluid management recommendations. There is ongoing national interest and participation in this review. The 16- to 18-year-old patients could potentially be managed on adult protocols in the future.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes