Endocrine Abstracts

Background: • Updated guidance on management of DKA in 2020.

• Main changes:

○ Diagnostic Criteria

▪ same ketone/pH criteria but serum bicarbonate level lower (<15 mmol/l)

○ Severity:

▪ pH <7.3 or bicarb <15=Mild DKA

pH <7.2 or bicarb <10=Moderate DKA

pH <7.1 or bicarb <5=Severe DKA

▪ previously pH >7.1 classified as “mild or moderate”.

○ Senior support - Previously recommended to discuss now “Always consult with the consultant paediatrician”

○ Resuscitation Fluids

▪ Shocked=20ml/kg over 15 mins

▪ Two further 10ml/kg can be given (up to 40ml/kg).

▪ Discussion with HDU as after 40ml/kg inotropes considered.

○Bolus Fluids

▪ Non-shocked DKA patients should get a 10ml/kg bolus over 60 mins

▪ IV fluids are not always required. Oral rehydration with monitoring of ketone levels can be used.

○Maintenance Fluids-

▪ Traditional Holliday-Segar formula.

▪ Grading severity=fluid deficit

▪ Maximum weight of 80 kg/97th centile for age (whichever lower)

○Potassium Maintenance

▪ If hyperkalaemic no additional potassium until urine passed or potassium back to normal.

○Insulin

▪ Consider long-acting subcutaneous insulin.

○Protocol used:

▪ Manage age 16-17 according to the guidelines for the teams they are under

Aims: • Primary

○Review guidance 1 year on regarding adherence to BSPED protocol.

• Secondary

○Compare with previous audit of length of stay of newly diagnosed.

Standards: • BSPED DKA Protocol 2020

Methods: • Admission notes reviewed 15/04/2020-15/04/2021.

Results: • Total number 17/28 in DKA.

• Bicarbonate range “incalculable”-18.9.

○94% <15.

• x8severe, x2moderate & x6mild DKA.

○All graded appropriately.

• Initial potassium 3.3-5.1.

○None needed consideration of when to add potassium to IV fluids.

• No 16-18yo admitted

• Consultant made aware of all admissions

• 100% appropriate bolus

• 100% appropriate IVF

○One managed with subcutaneous insulin and oral fluids

• 100% appropriate IV insulin

• Average length of stay 7.18 days

○Previous length of stay average 6.6 days

• 41% long-acting insulin started

Conclusion: • Good compliance/uptake of the new protocol.

• Slightly longer duration of stay.

• Some difficulties comparing to previous data as age of admission raised to 16.

• 17/28 newly diagnosed in DKA compared to 2017 audit 6/21 admissions. Not explained due to increase in age (1 patient >14y which was previous limit).