Management of diabetic ketoacidosis in PICU.

OBJECTIVE: This study was undertaken to analyze the outcome of children with DKA treated with a modified protocol at a tertiary level teaching hospital PICU in Pune, Maharashatra. METHODS: We retrospectively analyzed case records of 12 patients (8 males and 4 females) with DKA (11 new and 1 readmission) admitted in our PICU from January 2005 to June 2006. Patients were managed according to a modified protocol (that is with less intensive biochemical monitoring when compared with standard book protocols). Laboratory parameters measured were blood glucose, urinary ketones, electrolytes, urea creatinine, arterial blood gas (ABG) and infectious screen. Treatment included fluid therapy and insulin infusion- 0.1 u/Kg short acting intravenously followed by 0.1 u/Kg/hr. No bicarbonate was administered as a bolus. RESULTS: Total fluid deficit was corrected slowly over a period of 36 hr. The median time to normalize ABG was 19 hr (5.3-39) while the median time for the urinary ketones to disappear was 1day (1-3). The child to nurse ratio was 1:2, there were 2 pediatric residents in house all 24 hr with an intensivist and pediatric endocrinologist on call. CONCLUSION: We have shown that when DKA is managed in a PICU setting using modified protocol, the outcome is good and complications such as brain edema can be prevented.