An integrated care pathway for diabetic ketoacidosis

Abstract

Children and young people who are diagnosed with suspected insulin dependent diabetes mellitus (IDDM) may be relatively well and their clinical management comparatively straightforward but some may present in diabetic ketoacidosis (DKA). DKA, although relatively uncommon in children, is a dangerous condition carrying a significant morbidity and mortality rate. This article describes the development of an integrated care pathway (ICP) for the management of DKA in children and young people and its introduction within children’s services in a district general hospital. The care pathway amalgamates anticipated elements of care and treatment by all members of the multidisciplinary team for children with a provisional, new diagnosis of insulin dependent diabetes mellitus or for children with established diabetes who are unwell with raised capillary blood glucose with or without ketonuria and/or vomiting. The process of developing, implementing and evaluating the pathway will be discussed, including challenges and rewards encountered by the team. The working definition of DKA used for the pathway is: ‘decompensated diabetes mellitus with dehydration 5% or more with evidence of ketoacidosis (pH< 7.3 or plasma HCO < 18mmol/l, venous sample or heavy ketonuria)’.