[ Nutrition ]

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where

It is our opinion that the problem in the rehydration of the pediatric patient with DKA does not lie in assigning a maintenance fluid allotment. This can be high risk owing to multiple calculations, the need for addition of potassium containing fluids in clinical areas (a practice no longer recommended) and delays in administration of fluids. DKA patients were also compared with all PICU patients with CVC. Some studies report that a rate of more than 4 L per m2 per 24 hours is more likely to cause cerebral edema. Although not statistically significant, there was an equal number (n = 3) of adverse outcomes (death or neurological damage) in each group despite more than double the admissions in Group B (1264) compared with those in Group A (604). S. The median time to resolution was 18.7 h and the median length of hospital stay was 2.6 days.

Nadir effective plasma osmolality (Peff osm) and Peff osm levels also did not show statistically significant differences. Pretreatment blood gases were available for 477 episodes. However only 46% of patients requiring High Dependency Unit care were referred appropriately. The osmolality of ketoacids have been ignored in the past, as they are considered to be osmotically inactive and not contributing to osmotonicity.5 A study done by us (submitted for publication) has demonstrated that ketoacids (acetoacetates) are osmotically active. The two-bag system also had a faster time to ketone (p = 0.04), but not pH (p = 0.172), correction. Management of Diabetic Ketoacidosis  . In February 2012, led by the Adult Inpatient Diabetes Steering Group, the UHL NHS Trust implemented a revised DKA guideline based on the JBDS DKA guidelines.11 Implementation of the guideline was supported by a dedicated DKA prescription and monitoring chart.

It was agreed locally to retain the priming bolus dose of insulin since there was uncertainty about the timing of intravenous insulin administered to patients with DKA in the initial hours after admission to the UHL Emergency Department. The rate of bicarbonate correction, however, was faster with the two-bag system than the one-bag system (0.949 ± 0.553 mEq/L/hr and 0.606 ± 0.297 mEq/L/hr, respectively) (p = 0.047). UHL NHS Trust is one of the six biggest hospital Trusts in the UK, treating in excess of 1 million patients per year. Guess how much fluid he required?? We retrospectively reviewed case notes of all adult patients (>17 years of age) admitted at the Leicester Royal Infirmary, who were identified using a coded discharge diagnosis of DKA between February 2012 and December 2012. In severe insulin deficiency, for example in diabetic ketoacidosis, IGFBP-1 is upregulated while hepatic IGF-1 secretion is reduced, despite increased GH [2, 13, 14, 23]. Data were collected using an audit tool, modelled from the NICE inpatient foot audit tool and with standards derived from the JBDS DKA guidance.7 The audit tool covered all aspects of management from admission to discharge and adherence to the protocol/use of dedicated hospital DKA prescription and monitoring chart and clinical outcomes.

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