Endocrine Abstracts

Introduction: NICE Guidelines NG18 (published 2015) advocate a more conservative approach to management of diabetic ketoacidosis (DKA) in children and young people up to the age of 18, in an attempt to reduce the risk of cerebral oedema.

We aimed to assess if management of DKA in children at Manor Hospital was compliant with hospital guidelines, that were based on BSPED guidelines (issued 2009). We analysed the difference in total fluid administered if the new DKA guidelines were in place, specifically in the case of young people.

Method: We retrospectively audited case notes of all patients up to the age of 19 years admitted to Walsall Manor Hospital with DKA between 1st July 2014–31st July 2015 (n=13). A standardised proforma was used to collect data, which was then analysed.

Results: Current hospital policy advocates that young people after their 16th birthday are managed by the adult medical team. The adult DKA Guideline is based on recommendations of Joint British Diabetes Societies Inpatient Care Group recommendations (2013).

The age range was 10 to 18 years. Ten patients were treated using the paediatric and three were treated using the adult guidelines.

There was one significant fluid calculation error found in a patient treated with the paediatric guidelines, although the patient did not come to any harm. No fluid calculation error was found in those patients treated with adult guidelines, though one patient developed fluid overload not requiring active treatment. Mathematical modelling of fluid given in the first 12 hours of treatment shows that a young person would receive 40–70% less fluids if treated as per NICE NG18 instead of adult DKA Guidelines.

In terms of other complications, there were 12 episodes of hypoglycaemia, but no episodes of hypokalaemia in the 13 patients.

Conclusion: The risk of cerebral oedema is greatest in the first 12 hours of treatment. Patients between the ages of 16–19 treated with adult guidelines would receive significantly more intravenous fluid compared to paediatric guidelines, potentially increasing their chance of cerebral oedema.