Epidemiology and Outcome of Children with Diabetic Ketoacidosis Managed with the BSPED 2015 DKA Protocol

Background: This study aims to report why children with diabetes develop diabetic ketoacidosis (DKA) and what is the clinical course and complications encountered while managing the patients with British Society for Pediatric Endocrinology and Diabetes (BSPED) 2015 guidelines. Methods: This was a hospital based prospective, observational study conducted at a tertiary care hospital comprising of a total of 44 episodes of DKA. The patients were diagnosed and classified as mild to moderate DKA or severe DKA based on BSPED 2015 guidelines. Serial monitoring was done as per guidelines till resolution of DKA. Results: A total of 44 DKA episodes were documented. Eighteen patients (41%) were diagnosed with diabetes for the first time during the episode. Most common presenting complaint was vomiting and abdominal pain. Insulin omission completely or in part for variable reasons was the most common precipitating cause. The mean duration of correction of DKA was 27.2 ± 2.82 h. The rate of change in mean random blood sugar, ketones, pH, and bicarbonates for every 4 h of treatment was 15 mg/dL, 0.5 mmol/L, 0.03, and 0.53 mEq/L respectively. Complications during treatment included hypokalemia in 11 patients (25%), followed by cerebral edema in six patients (13.6%). Conclusion: We have described in detail the clinical course seen during treatment of DKA with BSPED 2015 protocol. It can be used to anticipate treatment course and complications in any patient being managed with this protocol. This can be objectively compared to any other protocol used during the management of DKA.