title: Analysis of the safety and efficacy of diabetic ketoacidosis management in a Community General Hospital, 2001-2010: a descriptive study.
abstract: BACKGROUND
  The recommended place for treatment of diabetic ketoacidosis in children is a paediatric High Dependency Unit. This facility is not available in all areas where children with type 1 diabetes mellitus are cared for.
  
  
  OBJECTIVE
  This study investigates the safety and efficacy of diabetic ketoacidosis management in a community general hospital without a paediatric high dependency unit.
  
  
  METHODS
  Data from children with diabetic ketoacidosis were collected from all diabetes related admissions in Dr Gray's Hospital, Elgin from 2001 to 2010. Observations were compared with safety indicators (pH, bicarbonate, glucose, electrolytes and cerebral oedema) and were reviewed for the recovery to normal values (pH, bicarbonate), without abnormal fluctuation (electrolytes, glucose) and without neurological complications (cerebral oedema).
  
  
  RESULTS
  The 114 patients generated 251 diabetes-related admissions, 118 for diabetic ketoacidosis treatment of whom 99 patients were treated with intravenous fluids and insulin. The mean time to recover to a pH of at least 7.30 was 655 minutes (120-1410 min). There were 79 (4.37% of 1808) glucose readings dropping more than 5.0 mmol/l per hour. There were six hypoglycaemic events (2.3-2.9 mmol/l) and in one case potassium dropped to 2.2 mmol/l. There was no case which developed into cerebral oedema.
  
  
  CONCLUSIONS
  Treatment of diabetic ketoacidosis in a community general hospital managed with a protocol for fluids, insulin and strict monitoring has shown to be effective in achieving recovery and to safely avoid complications.
authors.affiliation: Consultant Paediatrician, Paola Children's Hospital, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Peeters
authors.affiliation: Orthopaedic Senior Registrar, St Vincentius Ziekenhuis, Belgium.
authors.forename: W J
authors.initials: WJ
authors.lastname: van IJperen
authors.affiliation: Research Fellow, School of Medicine and Dentistry, Section of Population Health, University of Aberdeen, UK.
authors.forename: L
authors.initials: L
authors.lastname: Robertson
authors.affiliation: Research Fellow, Childsmile - North Region, NHS Grampian, UK.
authors.forename: P
authors.initials: P
authors.lastname: Royle
authors.affiliation: Consultant Paediatrician and Medical Ethicist, Forth Valley Royal Hospital, UK vanijperen@nhs.net.
authors.forename: W J
authors.initials: WJ
authors.lastname: van IJperen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D001929:Brain Edema / Q000517:prevention & control*; D002648:Child; D054869:Clinical Audit; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D011188:Potassium / Q000378:metabolism*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D014882:Water-Electrolyte Balance
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D011188:Potassium
keywords: - hyperglycaemia – management of DKA in CGH; Diabetic ketoacidosis