Endocrine Abstracts

Introduction: In August 2015, a revision of the BSPED-recommended guideline for the management of diabetic ketoacidosis (DKA) was published. A key difference from the previous guideline was a reduction in maintenance fluid rates, with the aim of reducing the incidence of cerebral oedema. Since implementation of these national guidelines, there have been reports within regional networks of an increased incidence in mild acute renal impairment and hypokalaemia. This retrospective audit aimed to compare the incidence of these complications pre- and post-implementation of the guidelines.

Methods: Databases were reviewed for all children newly-diagnosed to have diabetes who presented in DKA, in the 3 years prior to and following implementation of the latest BSPED DKA guidelines at the Royal Manchester Children’s Hospital. Data was collected on potassium (K), urea (Ur) and creatinine (Cr) at presentation and lowest K, peak Ur and Cr during admission.

Results: Twenty four children presented with DKA prior to guideline implementation and 23 following guideline implementation. There was no significant difference in mean lowest K (3.3 mmol/l pre, 3.1 mmol/l post, P=0.32) or mean difference between admission and lowest K (−0.9 mmol/l pre, −0.9 mmol/l post). Hypokalaemia, as defined by the BSPED DKA guideline (<3.0 mmol/l), during admission significantly increased since new guideline implementation – 21% (5/24) pre, 48% (11/23) post (P=0.05). There was no significant difference between mean peak Ur (6.5 mmol/l pre, 5.6 mmol/l post, P=0.40), or mean peak Cr (47 mcmol/l pre, 52.3 mcmol/l post, P=0.35). There was no mean difference between admission and peak Ur (+0.2 mmol/l pre, +0.3 mmol/l post), or between admission and peak Cr (+1.7 mcmol/l pre, +6.3 mcmol/l post, P=0.13).

Conclusion: Although there was no appreciable difference between the two groups in the lowest K or difference between admission K and lowest K, there is noted to be an increase in incidence of hypokalaemia during admission since the new DKA guidelines were introduced. In light of recent evidence that suggests the rate of intravenous fluid administration does not influence neurological outcomes, perhaps the current guidelines need review to reduce the incidence of hypokalaemia.