Endocrine Abstracts

Introduction: Diabetic Ketoacidosis is a life threatening emergency. BSPED has updated their guideline with changes in the fluid management (bolus dose for shock, de-escalate early use of inotropes, percentage dehydration in moderate DKA and maximum weight)

Aims: To determine the clinical features and outcome of new presentations of DKA in 0–16 year age range and audit fluid management

Methods: Patients 0-16 years presenting as new diagnosis of DKA over 18 months were recorded and management analyzed.

Results: 35 patients with DKA within 132 new diagnosis of type 1 diabetes in 0–16 Mean age 8 ½ years; youngest 16 months 18 male 17 female 20 self-presented to Emergency Department, 1 to ward, 14 GP referrals 16 Severe, 5 Moderate, 14 Mild DKA Paediatric Intensive Care admission in 6 patients. 15 patients had complications, hypokalaemia in 11 patients Average length of stay in hospital was 4.1 days Signs of Shock noted in 12 patients Fluid bolus appropriately administered in 33 patients. 1 had a 20 mL/kg bolus given when not shocked, 1 had a 10 mL/kg bolus when in shock and in severe DKA All 35 patients had percentage dehydration estimated appropriately

Maintenance fluids: Maintenance fluids were calculated appropriately in 30 patients. Of the 4 patients with inappropriate maintenance fluids, 1 had wrong estimated weight 3 did not get 10/kg bolus subtracted Dose of Insulin dose n=34 as one patient went to PICU prior to starting insulin infusion due to difficult access 29 started with 0.05 U/kg per hour and 5 had 0.1 U/kg per hour. 3 patients subsequently had insulin increased from 0.05 to 0.1 U/kg per hour. The average duration on the DKA protocol was 21 hours with a range of 8 hours to 2 days and 18 hours

Conclusions: A third of all cases of new diagnosis presented in DKA Male to Female ratio almost equal Just under half were severe DKA Less than 20% required PICU Fluid management was appropriate in over 90% of the cases with commonest error being maintenance fluid. Hypokalemia was the commonest complication and noted in 30% of all DKA despite appropriate fluid management There were cerebral edema or mortality