title: A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes.
abstract: We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05-0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers.
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.affiliation: Department of Pediatrics, Azienda Ospedaliera, "Ospedale Luigi Sacco", University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Scaramuzza
authors.affiliation: Department of Pediatrics, Endocrine Unit, Scientific Institute Hospital San Raffaele, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonfanti
authors.affiliation: UOSD Pediatric Diabetology, ASL NA2 Nord, Via Corrado Alvaro 8, Monteruscello, 80072 Pozzuoli, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Buono
authors.affiliation: Department of Pediatrics, U.O.S. Pediatric Diabetology, ARNAS Civico Di Cristina, Via Benedettini 1, 90134 Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardella
authors.affiliation: Pediatric Unit, S. Chiara Hospital, Largo Medaglie d'Oro 9, 38122 Trento, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cauvin
authors.affiliation: Regional Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, AOU Salesi Hospital, Via Corridoni 11, 60123 Ancona, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Cherubini
authors.affiliation: Postgraduate School of Pediatrics, University of Parma, Viale Gramsci 14, 43100 Parma, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Chiari
authors.affiliation: Clinica Pediatrica, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: d'Annunzio
authors.affiliation: Unit of Pediatric Diabetes, Brotzu Hospital, Piazzale Ricchi 1, 09134 Cagliari, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Frongia
authors.affiliation: Department of Pediatrics, Second University of Naples, Via S. Andrea delle Dame 4, 80138 Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maltoni
authors.affiliation: Endocrinology and Diabetes Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Ippolita Patrizia
authors.initials: IP
authors.lastname: Patera
authors.affiliation: Juvenile Diabetes Center, Anna Meyer Children's Hospital, Via Pieraccini 24, 50132 Florence, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Toni
authors.affiliation: Center of Pediatric Diabetology, University of Chieti, 66100 Chieti, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tumini
authors.affiliation: Department of Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Rabbone
authors.affiliation: Department of Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy.
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D015532:Rehydration Solutions; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007328:Insulin; D015532:Rehydration Solutions