Treatment of DKA in Queen Sirikit National Institute of Child Health according to Thai society for pediatric endocrinology guideline 2020

Abstract

Diabetic ketoacidosis (DKA) is a life-threatening condition in diabetes patients. It should be immediately diagnosed and managed to prevent morbidity and mortality. Management guideline for diabetic ketoacidosis and hyperglycemic hyperosmolar state in children and adolescent 2020 from Thai Society for Pediatric Endocrinology was the main protocol at Queen Sirikit National Institue of Child Health since January 2020. This study aimed to assess DKA treatment outcome and complications among children and adolescent patients at Queen Sirikit National Institue of Child Health. It was conducted as a retrospective descriptive study in patients who were admitted as DKA cases from January 2020 to June 2021. The collected data were patient characteristics, clinical manifestation, investigations, treatment methods and complications. Data analysis was presented in percentage, mean, median and standard deviation. As for the results, a total of 37 reviewed charts were collected. Most of the patients were diagnosed as severe DKA (73%). There were 90% of type 1 diabetes and 54% of newly diagnosed diabetes. The common chief complaints were dehydration (92%), Kussmual breathing (76%), and vomiting (73%). Infection was the most common precipitating factor for overall DKA patients (78%). In known diabetic patients, lack of insulin injection was the main factor (70%). Ninety-two percent of DKA patients were started the treatment at emergency room and received initial fluid management with 0.9%NaCl for 1-2 hours. The average time to start continuous insulin infusion was 1.4 hour. Insulin dose 0.1unit/kg/hour was started in 70% of patients. The mean duration to get rid of DKA was 14.8±5.8 hours. Hypokalemia was the most common complication (62%). Other complications were hyperchloremic metabolis acidosis, persistent acidosis, acute kidney injury, and cerebral edema. No mortality observed in this study. In conclusion, the common precipitating factors for DKA were infection and lack of insulin injection, Therefore diabetic self-management education (DSME) may have benefit for preventing DKA episode. The 2020 Thai Society for Pediatric Endocrinology guideline was effective for the treatment of DKA in this study. Closed monitoring and awareness for complications such as hypokalemia were recommended.