ESPE Abstracts (2014) 82 P-D-3-2-712

Diabetes (1)

Audit of the Use of Integrated Care Pathway in the Management of Diabetic Keto Acidosis in Children

Ravi Palakurthi & Kamal Weerasinghe


Wrexham Maelor Hospital, Wrexham, UK

Background: Diabetic keto acidosis is a complex metabolic state of hyperglycaemia, ketosis, and acidosis. Integrated care pathway for the management of DKA was introduced in 2007. At our hospital we use potassium infusion prepared by pharmacy that allows us to alter the rate of infusion for variable potassium delivery.

Objective and hypotheses: To check the adherence to integrated care pathway. To identify whether alteration of the rate of potassium infusion was needed in these children.

Method: Retrospective review of case notes of children admitted with DKA from April 2011 to July 2013.

Results: Nine out of 16 children (six males) were admitted with DKA as their first presentation. One hour interval from the start of rehydration fluid to the start of insulin was maintained in seven out of 16 children. Change of insulin infusion from 0.1 to 0.05 U/kg per hour was needed in 13 out of 14 children. One child who had GCS of 10/14 was treated for possible cerebral oedema and two children with GCS of 14/15 did not need specific treatment. Two of the three children on admission received insulin bolus subcutaneously, deviating from guideline. No other adverse outcomes were noted.

Conclusion: Adherence to the integrated care pathway facilitated appropriate management of children presenting with DKA. Areas for improvement in practice including need for effective documentation were identified. Alteration of potassium infusion rate was not needed and episodes of hypokalemia were not documented. This led us to reconsider our practice of providing potassium infusion prepared in-house in the pharmacy. Standard replacement fluid with 40 mmol/l may be sufficient. All teams who could potentially get involved in the management of children with DKA need to be familiar with the guidelines to optimise their care.

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