Clinical reaudit on management of diabetic ketoacidosis in Assiut University Children Hospital

Abstract

Introduction Diabetic ketoacidosis (DKA) is one of the most common causes of admission in emergency unit and pediatric ICU in Assiut University Children Hospital. It is one of the important causes of mortality and morbidity in children with diabetes. DKA is a complex metabolic state of hyperglycemia, ketosis, and acidosis resulting from absolute or relative insulin deficiency. Patients and methods The study includes pediatric patients presented with DKA to emergency unit and pediatric ICU of Assiut University Children Hospital. It was done on 100 pediatric patients over 1 year from March 2017 to February 2018. This reaudit was done to evaluate the degree of compliance of management of DKA in relation to the guidelines in comparison with the previous study on the same topic that applied the same guidelines (International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2014). Results Overall, 63% were females and 39% were in the age group older than 10 to 15 years. Resuscitation fluids were administered in 95% of cases on admission. All cases received insulin therapy with the start of resuscitation fluids. Glucose 5% was correctly added to intravenous fluids when blood glucose had fallen to ~14–17 mmol/l (250–300 mg/dl) in all cases. Conclusion Guidelines have been followed in the management of DKA in the studied cases, but there were some defects that can affect the outcome of management of DKA. The study recommends avoiding these defects.