Endocrine Abstracts

Introduction: Diabetic Ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes mellitus (T1DM) in children and young people (CYP). A 5th edition Integrated Care Pathway (ICP) for the management of DKA was published in 2022 in Wales based on updated guidance from BSPED, NICE, and the UK resuscitation council.

Objective: To audit the management of DKA in CYP at Noah’s Ark Children’s Hospital for Wales following the introduction of the 5^th edition ICP, and compare to management using the 4^th edition ICP, to determine areas of change and potential improvement.

Methods: Retrospective case note review of CYP admitted in DKA, managed on current guidance between 01/04/2022 and 31/03/2024 and compared with the previous audit based on interim guidelines between 01/04/2020 and 31/03/2022.

Results: In the current audit, 21 episodes occurred in 20 CYP (13 male). The median age was 12 years (range 8 months to 15 years). All patients were appropriately diagnosed and 7 CYP presented in severe DKA, 5 moderate DKA and 9 mild DKA. This data was consistent with the previous audit. However, there has been an increase in presentations from CYP with an established diagnosis, 38% (8/21) vs 15% (3/20). In both audits, all had appropriate fluid boluses and maintenance intravenous fluids prescribed. In the current audit, initiation of fluids was delayed in 52% (11/21) episodes compared to 35% (7/20) previously and intravenous insulin was delayed in 67% (14/21) episodes compared to 50% (10/20). Hypokalaemia was noted in 48% (10/21) of episodes and hypoglycaemia was noted in 24% (5/21) whilst on the pathway, consistent with the previous audit.

Conclusion: The updated ICP was generally followed accurately, and all patients were diagnosed appropriately with no adverse outcomes identified. The commencement of intravenous fluids and insulin was delayed on over half of the patients, an increase from the previous audit. Additionally, half of CYP experienced hypokalaemia which needs to be compared with other centres and closely monitored. The increase in number of established CYP presenting in DKA is being reviewed and staff education is planned to improve the timeliness of DKA management.