Paediatric DKA in an East London District General Hospital Dipak Mistry
“TRIAGED STRAIGHT TO PAEDIATRICIANS?” "Very low rates of DKA overall." "Only 1 patient documented to have been treated by an ED doctor."
"ED doctors may lose necessary skills without exposure to cases."
MANAGEMENT FOLLOWED BSPED GUIDELINES WITH VERY LITTLE VARIANCE 9 cases of DKA – 6 first presentations of diabetes.
Specialty Registrar in Emergency Medicine
8 cases treated by paediatric StRs & 1 case by an ED StR
Homerton University Hospital, London, E9 6SR
Fluids: up to 25mls/kg in divided doses. Dehydration estimated to be 5% and rehydrated over 48 hours.
References 1. Glaser NS, Kuppermann N, Yee CK, Schwartz DL, Styne DM. Variation in the management of pediatric diabetic ketoacidosis by specialty training. Archives of pediatrics & adolescent medicine. 1997; 151(11):1125–32. 2. BSPED Recommended DKA Guidelines 2009. http://www.bsped.org.uk/clinical/docs/DKAGuideline.pdf
Insulin infusion: 0.1 – 0.05 units/kg/hr. 7 patients were transferred out for HDU care – no cases of cerebral oedema.
Acknowledgements Snehal Sanghani
24 MONTH RETROSPECTIVE AUDIT EPR search = “DKA” AND OR “diabetes” AND OR “generally unwell & diabetes” AND OR “cerebral oedema” AND OR “low GCS”.
Record: age, sex, time of presentation, blood gas specialty, complications, disposal.
WHY? Specialty specific differences to resuscitation in paediatric DKA have been documented in the past . British Society of Paediatric Endocrinology 2009 guidelines .
Are there any real specialty treatment?
All patients followed up even if transferred out.