Endocrine Abstracts

Introduction: Diabetic Ketoacidosis (DKA) is a potentially life threatening complication of type-1 diabetes mellitus (T1DM) in children and young people (CYP). An Integrated Care Pathway (ICP) for management of DKA is based on the current British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines. The BSPED guideline moved away from cautious fluid replacement toward a liberal approach for resuscitation and maintenance fluids based on current evidence. The ICP has been established in Wales with the 6th edition published in March 2022 following the NICE guideline update.

Objectives: To audit the management of DKA at the Children’s Hospital following the introduction of the interim BSPED guidelines on which the 5th edition of ICP was based.

Methods: Retrospective case note review of all CYP admitted in DKA over 24 months between 01/04/2020 and 31/03/2022.

Results: A total of 20 episodes of DKA were recorded in 19 patients (14 of them were male). The median age was 13 years (range 1 to 16 years). 17 of the episodes were in newly diagnosed CYP. In all cases, the diagnosis of DKA was made appropriately per the current guidance. 11 CYP presented in mild DKA, 4 in moderate DKA and 5 in severe DKA, all of whom received appropriate fluid boluses and the fluids as recommended. Hypoglycaemia was reported in 4 of the 20 episodes whilst on the pathway, and hypokalaemia was reported in 11 of 20 episodes despite having recommended potassium in the fluids. There were no episodes of cerebral oedema.

Conclusions: The ICP was used in all cases and in general followed well. The increased incidence of hypokalemia despite following the pathway needs further evaluation and comparison with other centres using the ICP and BSPED guidance. However, no adverse outcomes were identified. We need to audit the most recent update of the ICP to recommend further changes.