Endocrine Abstracts

Background: Approximately 1/3 of children newly diagnosed with type 1 diabetes (T1D) present with diabetic ketoacidosis (DKA). Despite the progress made in managing T1D, DKA continues to pose a substantial risk for existing and new patients with T1D. The British Society for Paediatric Endocrinology and Diabetes (BSPED) published guidelines for the management of DKA in 2021 and this protocol was adopted by Bristol Royal Hospital for Children.

Methodology: Retrospective data collection for children presenting with DKA from 01/01/2022 to 31/12/2022 was done and compared to 23 audit standards. They included correct identification of DKA, fluid management, giving insulin as per the BSPED protocol, electrolytes monitoring, investigations for the newly diagnosed patients, and the timing of medical reviews.

Results: 29 patients were diagnosed with DKA (n=13 males and n=16 females). Their age ranged between 0.8 – 15.4 years with a mean age of 10.7 years. 28 (96.6%) had a correct diagnosis of DKA so were included in the results. 12 patients presented in severe DKA (43%), 7 were in moderate DKA (25%), and 9 were in mild DKA (32%). 18 patients (64.3%) were newly diagnosed with T1D. One patient presented following a cardiac arrest at home. 9/23 (39%) audit criteria achieved full compliance with audit standards which included correct classification of the degree of DKA, initial fluid bolus, deficit and maintenance fluid calculation, hourly blood glucose, 1–2 hourly ketone monitoring, initial U&E, prescribing of potassium in the IV fluids and insulin infusion rate. Medical reviews 2 hours after starting treatment were fulfilled in 96% of patients and starting insulin within 1–2 hours was achieved in 93%. Criteria that needed improvement included, documenting the initial GCS (75%), following it up at regular intervals (64%), and checking 4 hourly U&Es (61%).

Conclusion: Particular focus needs to be made to ensure timely checking and documenting GCS, 4 hourly U&Es, and hourly fluid balances. Therefore, a patient safety message was circulated to all staff, highlighting the areas that needed improvement. Additionally, further training sessions were conducted to enhance DKA management skills, focusing on various scenarios that were identified as problematic during the audit.