Endocrine Abstracts

Introduction: Diabetic ketoacidosis (DKA) remains a life threatening complication in type 1 diabetes. Appropiate initial management is crucial in the evolution of this complex condition, and mistakes in the treatment are not uncommon.

Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce.

We introduce a new simulator designed in our institution aimed to junior doctors’ training in DKA treatment whose implementation permits physicians to solve more case than what they would manage in the Emergency Room.

Material and methods: A software was developed by using mathematic algorithms based in previously published and empiric formulas to simulate the evolution of DKA both under appropriate and inappropriate management.

Results: The DKA simulator shows several cases to the trainee. Every case is compound by a clinical history and some variables which define the basal situation of the simulated patient: sex, age, weight, glucose, 3-β-OH-butyrate, sodium, potassium, serum creatinine, renal function, grade of dehydration, insulin sensitivity and ability to hyperventilation. The last four parameters are not shown to the trainee, but used by the simulator.

The trainee has to indicate the initial management, ask for biochemical test when necessary, and make successive changes in the treatment (iv insulin rate, type and rate of fluidotherapy and potassium administered) until DKA resolution is reached or, eventually, the death of the patient happens if the management has not been correct. By using mathematical algorithms, and according to the characteristics and the duration of the treatment, our simulator provides a clinical and biochemical evolution in the patient.

Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic patient.