Adherence to Guidelines in the Treatment of Diabetic Ketoacidosis in Children: An Austrian Survey.

Abstract:

BACKGROUND:The aim of this study is to assess the adherence of Austrian physicians to International Society for Pediatric and Adolescent Diabetes guidelines 2009 concerning treatment in diabetic ketoacidosis and whether there is a difference between specialty (endocrinologists or intensivists) or clinical experience. PATIENTS AND METHODS:An online questionnaire was sent to members of the working groups of the Austrian Society of Pediatric and Adolescent Medicine. RESULTS:Of 106 questionnaires, 56 were included in the analysis. The mean ± SD overall adherence was 60 ± 23.5%. Endocrinologists showed a nonsignificant higher result, related to a significant higher adherence regarding the amount of fluids (P < 0.05) and tendency to bicarbonate use (P = 0.052) respectively. No differences were found between participants with different clinical experience. All gave crystalloids, 55% administered initial bolus of 10 to 20 mL/kg per hour, 58% used 1.5 to 2 times fluid maintenance, 87% started insulin after first fluid bolus, 28% gave 0.05 and 0.1 IE/kg per hour to infants and children respectively, and 43% 0.05 IE/kg per hour to all patients. When blood glucose falls, 53% gave glucose and 47% reduced insulin. In cerebral edema, 46% gave at least 2 of 3 recommended measures (fluid reduction, mannitol, or hypertonic saline). In acidosis (pH <6.9), 25% administered bicarbonate (as per guideline) and 52.9% never gave bicarbonate. CONCLUSIONS:Adherence to the actual guidelines is 60% and does neither depend on speciality nor on clinical routine. Essential treatment measures (eg, amount of fluids, consequence of rapid glucose fall, bicarbonate use) are not commonly known.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Weinberger K,Seick Barbarini D,Simma B

doi

10.1097/PEC.0000000000001551

subject

Has Abstract

pub_date

2018-07-24 00:00:00

eissn

0749-5161

issn

1535-1815

pub_type

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