Carolinas Research Day 2021

Clinical Studies

02 Evaluation of the Diabetic Ketoacidosis Management in the Critically Ill Children and Adolescents

Mackenzie Dreher, OMS-IV, MPH, Brittany Skaggs, OMS-IV, Christine Angeles, OMS-IV, Alyssa Davolio, OMS-IV, Jacob Andrews, OMS-IV, Ning Cheng, MS, PhD, Hanna S. Sahhar, MD, FAAP, FACOP

Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg Regional Healthcare System

Study Aim: The purpose of this study is to re- evaluate diabetic ketoacidosis (DKA) management protocol for type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in the pediatric intensive care unit (PICU) of Spartanburg Regional Healthcare System; in order to determine the time, and amount of fluids and insulin needed to resolve the metabolic acidosis and dehydration. Research Method: A retrospective chart review of 247 patients, ages 0 to 17 years old, admitted to the Pediatric Intensive Care Unit (PICU) of Spartanburg Regional Health System met the diagnostic criteria for diabetic ketoacidosis (DKA). This study was approved by Spartanburg Regional Healthcare System Institutional Review Board Data Analysis: Descriptive statistical analysis, simple linear regression, and Fisher’s exact test were performed to assess for significance (p≤0.05) using SPSS Data Analysis Software. Results: The study included 247 patients, 55.9%

female and 44.1% male, 48.8% white and 48.4% African American. T1DM encompassed 97.6% and 28.3% of all patients had new onset diabetes. Population age groups were 13-17 years old at 60.7% followed by 6-12 years old at 32.8%. Primary outcomes analyzed the average time to correct metabolic acidosis (serum bicarbonate >14.99 mEq/L), 5.98±9.58 hours, and the average amount of fluids and insulin per kilogram to correct dehydration (serum bicarbonate >17.99 mEq/L) at 114.38±148.72 mL/kg and 2.6±5.5 units/kg, with a mean drip rate of 0.098±0.174 units/kg/hr. Secondary outcomes analyzed average length of stay (LOS), complications of admission (arrhythmias, cerebral edema, and hypoglycemia), and change in heart rate (HR) from initial presentation to correction of acidosis and resolution of dehydration. The PICU LOS averaged 1.54±1.06 days. Complication incidents were cerebral edema at 4%, arrhythmias at 2% and hypoglycemia at 1.6%. Further analysis related complications to a factor during initial emergency

room management: administration of insulin bolus, sodium bicarbonate, ≥2 fluid boluses at 20 ml/kg each, or a fluid bolus >20 ml/kg. The incidence of cerebral edema was significantly related to the use of sodium bicarbonate (p=0.034). Lastly, significance was noted between the decrease in HR from baseline to correction of acidosis and baseline HR to resolution of dehydration; with an average decrease of 35 and 50 beats per minute respectively (p<0.001). Conclusion: Following the DKA protocol in the PICU is imperative to minimize DKA complications such as cerebral edema, while also reducing the amount of time a patient spends admitted to the PICU. Results showed complications of cerebral edema were related to administration of a sodium bicarbonate bolus in the emergency department. The duration of time to resolve metabolic acidosis and the amounts of fluids and insulin to correct for dehydration are reported in this study with emphasis on continuing the fluid and insulin treatment until the resolution of the dehydration, rather than just the correction of metabolic acidosis.

20