Time to fluid administration in paediatric diabetic ketoacidosis

Abstract

BACKGROUND: Diabetic ketoacidosis is a medical emergency and merits prompt fluid therapy. Our aim is to evaluate whether fluids are started within one hour of presentation to hospital for children with diabetic ketoacidosis.

METHODS: This is a retrospective study involving patients with diabetic ketoacidosis presenting to paediatric emergency department at Mater Dei Hospital between 2008 to 2017. Diabetic ketoacidosis was defined as per local protocol. Times at hospital presentation, medical visits in emergency department and wards and at start of fluid administration were recorded. Clinical and biochemical parameters for patients with start of fluids within one hour (Immediate Fluid Treatment) were compared to those with delayed fluid treatment; T-test was used for significance.

RESULTS: Sixty episodes were included, with 34 males (60.7%) and mean age 7.42 years. Fluids were started at a median of 95.5 (IQR: 70.5 - 128.3) minutes following presentation and were mainly started in the admitting ward. Only 18% of patients received fluids within one hour of presentation (n = 11). Bicarbonate and pH levels were significantly lower in these patients, at 7.87 vs 11.48 mmol/l (p = 0.027) and 7.07 vs 7.21 (p = 0.002) respectively, when compared to those with delayed fluid treatment. Significantly more patients in the immediate fluid treatment group needed fluid boluses (73% vs 29%, p = 0.0006).

CONCLUSION: Fluids were delayed more than one hour from presentation in most paediatric diabetic ketoacidosis patients. Consideration should be given to commencing fluids in the paediatric emergency department or expediting their ward transfer, to decrease this delay in starting treatment.