ESPE Abstracts

Introduction: During management of Diabetic ketoacidosis (DKA), and after starting the insulin infusion, it is crucial to monitor the blood glucose level frequently. If the glucose level drops quickly or below certain limit when there is still an evidence of ketonemia, it is recommended to add dextrose to the maintenance fluids and continuing the insulin infusion to switch off the ketosis process. However certain measures are required when the glucose continues to drop, and the patient becomes truly hypoglycaemic with a glucose level below 4 mmol/l. These measures include giving a dextrose bolus intravenously, stopping the insulin infusion temporarily and adding more dextrose to the maintenance fluids.

Objectives: This study aims to evaluate the performance of Bahraini, Iraqi, and Saudi paediatric residents throughout their different levels of training (year 1 to 4), regarding how to manage a DKA patient who drops a glucose below 4 mmol/l whilst the patient is still ketonemic and still on intravenous fluids and insulin.

Methods: An online survey using SurveyMonkey was sent out to the paediatric residents practicing in Bahrain, Iraq, and Saudi Arabia between May and July 2020, giving a scenario to evaluate their management when a DKA patient drops the glucose below 4 mmol/l. Responses received anonymously.

Results: 142 residents responded (41 from each Bahrain and Iraq, and 60 from Saudi Arabia). Correct answers were given by only 19%, 22% and 27% of the responded Iraqi, Saudi, and Bahraini paediatric residents respectfully. 15%, 24%, and 32% of Saudi, Bahraini and Iraqi residents respectfully preferred giving a dextrose bolus intravenously only, and 10-12% of the responders wanted just stopping the insulin infusion temporarily. Majority of the residents (90%, 83%, and 66% from Iraq, Saudi Arabia, and Bahrain) feel that further educational sessions about details of DKA management is definitely needed. Whereas the rest may attend such educational activities if provided.

Conclusion: Gap in knowledge of managing hypoglycaemia during the treatment of DKA was evident among junior and senior residents from the three studied countries. Further training and education are recommended, and perhaps adding more details about management of hypoglycaemia to the existing protocols in the studied countries will raise more awareness and give guidance on dealing with the possible outcomes and complications.