Endocrine Abstracts

Aim: To evaluate the management of paediatric diabetic ketoacidosis (DKA) across the Emergency Department (ED) and Paediatric Ward, focusing on adherence to locally adapted BSPED guidelines and identifying and addressing the factors contributing to deviations.

Methods: A retrospective audit was conducted on all Paediatric DKA presentations to the ED between January and March 2025. Management was assessed against key BSPED DKA guideline components: diagnosis, clinical observations, fluid and insulin administration, investigations, and transition to subcutaneous (SC) insulin. Deviations were analysed, and contributing factors identified. In response, an action prompting aid and medical and nursing staff DKA competency tools were developed.

Results: Six patients presented with DKA during the study period, most being new diagnoses; one had known type 1 diabetes. Three patients were diagnosed to have severe DKA, and three mild to moderate DKA. Two of them attended the primary care physician in the preceding week. Diagnosis and initiation of treatment were timely in all cases. Initial fluid boluses were appropriate, though in one case with shock, the bolus was incorrectly subtracted from total fluid calculations. Intravenous insulin was initiated promptly in all but two cases, where delays were due to the lack of a second functioning cannula. Monitoring met standards in severe cases but was delayed in mild to moderate DKA. Transition to dextrose-saline fluids and SC was appropriate in all but one case, where a delay occurred during ED-to-ward transfer. An action prompting visual flowchart, designed to support real-time nursing decision-making, received excellent feedback and integrated into the ED app. Competency tools for both medical and nursing staff were well received, with training now aligned to these standards.

Conclusion: DKA management aligned well with BSPED guidelines for most patients. Deviations such as delayed insulin initiation, fluid miscalculations, and transition delays, were primarily linked to human factors. The introduction of visual aids and competency tools have been positively received and are expected to improve compliance, safety, and outcomes in our Paediatric DKA care.

Reference: 1. BSPED Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis – 2021. Available: https://www.bsped.org.uk/clinical-resources/bsped-dka-guidelines/