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

Endocrine Abstracts (2019) 66 P60 | DOI: 10.1530/endoabs.66.P60

Audit on the management of diabetic ketoacidosis in children in 2 District General Hospitals: creation of a DKA pathway

Rabbi Swaby, Izzuddin Nor & Tanya Naydeva-Grigorova

United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK

Introduction: Diabetic Ketoacidosis (DKA) is a common complication of Type 1 Diabetes (T1DM), accounting for around 21% of all diabetes related admissions. It is a major source of morbidity and mortality amongst children with T1DM. Delayed diagnosis, shock, renal failure, cerebral oedema and sepsis remain problematic. The aim of this project was to compare local management to best practice as per the British Society for Paediatric Endocrinology and Diabetes (BSPED), and provide intuitive ways to improve patient management.

Methods: A retrospective audit of the case notes of patients aged 0–16 attending A&E across two sites of the trust were identified using the clinical code ‘Type 1 Diabetic with Ketoacidosis’. A 1 year period was analysed. Standards were set as per BSPED, which included correct diagnosis, correct fluid choice, initial fluid resuscitation including fluid calculations, timing of insulin, and monitoring of blood sugars, blood gases and neurological monitoring if appropriate.

Results: Overall twenty-four patients were admitted across our two sites (n total = 24). 96% of patients were correctly diagnosed and the average time to fluid initiation was 15 min. The average time between initiation of fluids to insulin was 1 h 23 min, although 12.5% of patients had their insulin started after 15 min of fluids. Around 30% of patients received a fluid bolus despite not being recorded as shocked. 83% of patients had appropriate fluids used including potassium. Only 60% of patients had hourly blood sugar monitoring and a minimum of 4 hourly blood gases/U&E monitoring. 58% of patients had their fluid calculations recorded. Around 80% were resuscitated over 48 h, and 90% had their fluids based on weight. 70% of those requiring neuro-obs received them as per protocol.

Conclusion: Whilst most patients were correctly diagnosed, there were many inconsistencies in DKA management. Therefore, we have implemented several measures to aid clinicians. Firstly, ensuring regular education of healthcare professionals on T1DM and DKA. Secondly, creating a DKA pathway to aid clinicians from the initial assessment to recovery of DKA. It will aid in diagnosis, initial fluid resuscitation, accurate fluid calculation and monitoring.

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