ESPE Abstracts (2014) 82 P-D-3-1-700

Diabetic Ketoacidosis in Children with T1DM: an Italian Multicentre Survey

Stefano Zucchinia, Riccardo Bonfantib, Pietro Buonoc, Francesca Cardellad, Vittoria Cauvine, Valentino Cherubinif, Giovanni Chiarig, Giuseppe D’Annunzioh, Anna Paola Frongiai, Dario Iafuscoj, Giulio Maltonia, Patrizia Ippolita Paterak, Andrea Scaramuzzal, Sonia Tonim, Stefano Tuminin & Ivana Rabboneo

aDepartment of Women’s and Children’s Health, S.Orsola-Malpighi H., Bologna, Italy; bDiabetes Research Institute, San Raffaele H., Milan, Italy; cDepartment of Pediatrics. University of Naples Federico II, Naples, Italy; dPediatric Diabetology Unit Children H. G Di Cristina, Palermo, Italy; ePediatric Diabetology Unit, S.Chiara H., Trento, Italy; fDepartment of Women’s and Children’s Health, AOU Ancona, Ancona, Italy; gDepartment of Pediatrics, Pediatric Diabetes Regional Center, General Hospital of Parma, Parma, Italy; hDepartment of Pediatrics, Pediatric Diabetes Regional Center, Gaslini H., Genova, Italy; iPediatric Unit, Brotzu H., Cagliari, Italy; jDepartment of Pediatrics, Second University of Naples, Naples, Italy; kEndocrinology and Diabetology Unit, Bambino Gesù Children’s H., Rome, Italy; lDepartment of Pediatrics, Diabetology Unit, Sacco H., Milan, Italy; mPediatric Diabetology Unit, Meyer Children H., Florence, Italy; nDepartment of Pediatrics, University of Chieti, Chieti, Italy; oDepartment of Pediatrics, University of Turin, Turin, Italy

Background: Data regarding epidemiology and management of Diabetic Ketoacidosis (DKA) in Italian children with T1D at disease onset are lacking.

Method: From 1/1/2012 to 31/12/2013 a survey on DKA was conducted in all paediatric Centres belonging to the Italian Society for Pediatric Diabetology and Endocrinology. DKA was defined according to the ISPAD criteria. The following data were collected: treatment according ISPAD protocol yes or not, type of rehydrating solution used, bicarbonates use yes or not and amount of insulin infused.

Results: Data were returned from 68/77 Centres (87%) for a total of 14.493 patients with T1D. We recorded 2453 children with T1D onset, with DKA in 945 (38.5%) (severe in 10.3%). Considering only preschool children DKA was observed in 72% (severe in 16.6%). Cerebral oedema following DKA treatment was observed in five cases (0.5%). DKA treatment according ISPAD guidelines was adopted in 67% of the Centres, while 11% did not follow any specific guidelines. In the first 1–2 h, rehydration was started with normal saline, at different rates: 5–10 ml/kg per h in 71%, 10–20 ml/kg per h in 16%, <5 ml/kg per h in 4%. After the first hours, differences among Centres were observed regarding the type of solutions used: saline 0.9–0.45% in 75%, 5–10% glucose solution in 19%, irrespective of glycemic values. Potassium supplementation was performed at the rate of 20–40 mEq/l in 63% of Centres. Bicarbonates were never used in 17% of Centres, while in 68% were exceptionally used according to pH and clinical conditions. Insulin was infused starting form 2nd–3rd hour at the rate of 0.05–0.1 U/kg per h in 63% of Centres, while others used infusion rate lowest as 0.025 U/kg per h.

Conclusion: Notwithstanding prevention campaign, DKA is still observed at clinical diabetes onset in Italian children. Despite international guidelines (ISPAD), significant variability in DKA treatment still exists, underlying the need to share them among Centres.