Endocrine Abstracts

Diabetic Ketoacidosis (DKA) is a significant complication of paediatric diabetes, the effective management of which relies on meticulous calculations, and timely decision making in response to changing physiology. A previous regional audit in South West England has shown that compliance with national guidelines is highly variable, and errors in calculations such as fluid rates are common. Fluid management in paediatric DKA is a subject of ongoing debate and changing guidance. In addition the multi-step nature of some of these calculations may contribute to this variability in practice. To address this safety concern we developed a clinical decision aid: the ‘DKA Calculator’. Clinicians can use this tool to generate an individualised version of the BSPED Integrated Care Pathway (ICP) for the management of children and young people with DKA, with important variables calculated automatically and pre-filled. These include bolus volumes, fluid and insulin rates, and a suggested timeline for clinical reviews. We hope that providing pre-calculated values for the clinician will add an additional layer of protection against errors, especially when combined with the clear flowchart structure of the ICP. The ‘DKA Calculator’ is a web application that accepts inputted data such as blood pH, patient weight and the presence of shock. Relevant calculations are performed on the client device using JavaScript. The ICP with these pre-filled values can then be downloaded as a PDF document and printed for use in the patient notes. Data entered into the application (excluding patient identifiable data) is stored in a pseudo-anonymised state for future audit. The programmed logic underwent internal review and is available open-source on GitHub. The ‘DKA Calculator’ is registered with the MHRA as a medical device in the UK. We describe the development, testing and release of the DKA Calculator, and proposals for future advancements.