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Current Variability of Clinical Practice Management of Pediatric Diabetic Ketoacidosis in Illinois Pediatric Emergency Departments

Barrios, Ellen K. MD*; Hageman, Joseph MD; Lyons, Evelyn RN, MPH; Janies, Kathryn BA§; Leonard, Daniel MS§; Duck, Stephen MD; Fuchs, Susan MD

doi: 10.1097/PEC.0b013e3182768bfc
Original Articles

Objective This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program.

Methods In 2010, Illinois EMSC conducted a survey (including case scenarios) and medical record review regarding management of pediatric patients with DKA. Data were submitted by 116 EDs.

Results Survey response rate was 94%. Only 34% of EDs had a documented DKA guideline/policy; 37% reported that they did not have hospital adult or pediatric endocrinology services. Case scenarios identified a high percentage of respondents given an intravenous (IV) isotonic sodium chloride solution of 10 to 20 mL/kg during the first hour. However 17% to 21% would use an alternative choice such as administering initial IV solution of 0.45 sodium chloride, initiating an insulin drip before fluids, or waiting for more laboratory results before giving fluids or insulin. A total of 532 medical record reviews were submitted. In 87% of records, patients received an initial IV isotonic sodium chloride solution within the first hour. In 74%, patients received IV insulin infusion/drip (0.1 U/kg/h) after the initial fluid bolus. Of the patients, 51% were transferred to another facility; 22% were admitted to an intensive care unit.

Conclusions Best ED practice management of pediatric DKA includes establishing a specific guideline/protocol and ensuring access to a pediatric endocrinologist. Both were identified as improvement areas in this project. Illinois EMSC has developed an educational module and provided direct feedback to all participating EDs, to improve their management of pediatric patients with DKA.

From the *Lawndale Christian Health Center; †Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago; ‡Illinois Department of Public Health, Springfield; §Department of Pediatrics, Stritch School of Medicine, Loyola University, Maywood; and ∥NorthShore University HealthSystem, Evanston, IL.

Disclosure: The authors declare no conflict of interest.

Reprints: Joseph Hageman, MD, NorthShore University Health System, 2650 Ridge Ave, Evanston, IL 60201 (e-mail:

This study was supported by EMSC Targeted Issue Grant # H34 MC08516, Maternal and Child Health Bureau, Health Resources and Services Administration.

Presented at the Pediatric Academic Society Meeting, Denver, Colorado, May, 2010.

© 2012 Lippincott Williams & Wilkins, Inc.