Endocrine Abstracts

Introduction: Diabetic Ketoacidosis (DKA) is a life threatening complication of type 1 diabetes mellitus (T1DM) in children. An integrated care pathway (ICP) for management of DKA based on guidelines published by the British Society for Paediatric Endocrinology and Diabetes has been established in Wales with the 2nd edition published in May 2010.

Aims: To audit the management of DKA in a teaching hospital following the introduction of the second edition of the ICP and identify the precipitants of DKA.

Methodology: Retrospective case note review of all children admitted with DKA between June 2010 and September 2011.

Results: 24 episodes of DKA were recorded in 17 patients (12 male). The median age was 12.9 years (range 4–16.6 years). Seven of the DKA events were in newly diagnosed T1DM and omission of insulin was the most common precipitant in the other cases.

In all cases the diagnosis of DKA was made appropriately using blood sugar >11 mmol/l and pH <7.3.

The initiation of intravenous fluids was delayed and calculated wrongly in a quarter of the patients.

Hypoglycaemia was documented in 17 of the 24 episodes whilst on the pathway despite having dextrose in their fluids.

Conclusion: The ICP was used in all cases and in general followed well. The increased incidence of hypoglycaemia despite following the pathway needs further evaluation and comparison with other centres using the ICP. In a significant proportion of episodes, treatment was delayed and fluids calculated inappropriately. However, no adverse outcomes were identified.