Variability in Emergency Management of Pediatric Diabetic Ketoacidosis
| Autor: | David S Saleh, Helen Coo, Keith Gregoire, Zoyah Thawer |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Diabetic ketoacidosis Endocrinology Diabetes and Metabolism medicine.medical_treatment Brain Edema 030209 endocrinology & metabolism Diabetic Ketoacidosis Cerebral edema 03 medical and health sciences 0302 clinical medicine Endocrinology Bolus (medicine) Diabetes mellitus Chart review Diabetes Mellitus Internal Medicine medicine Humans Insulin Initial treatment 030212 general & internal medicine Risk factor Child Retrospective Studies business.industry General Medicine medicine.disease Hospitalization business |
| Zdroj: | Canadian Journal of Diabetes. 45:757-760 |
| ISSN: | 1499-2671 |
| DOI: | 10.1016/j.jcjd.2021.03.003 |
| Popis: | Objectives Our aim in this study was to identify pediatric patients presenting in diabetic ketoacidosis (DKA) who received initial treatment inconsistent with current guidelines, and then to track associated complications. Methods This retrospective chart review examined 47 pediatric patients admitted to our institution with DKA, including those transferred from community hospitals. Primary outcome measures were exposure to treatment-related risk factors for cerebral edema (CE), including administration of an intravenous (IV) insulin bolus, IV bicarbonate, insulin within 1 hour of IV fluid start and non-NPO (nil per os) status. Results Seventy-five percent of patients were exposed to at least one management practice that deviated from guidelines. Thirty-four percent of patients were exposed to a treatment-related risk factor for CE, with a significantly higher prevalence in those presenting to community centres (52% vs 19%; p=0.02). There were no radiologically confirmed cases of CE. Conclusions Despite the presence of multiple, evidence-based guidelines, a significant proportion of children---and especially those who present to community centres---are exposed to practices that increase CE risk. |
| Databáze: | OpenAIRE |
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