Nonadherence to potassium replacement protocol leads to prolonged management of diabetic ketoacidosis.

Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management. Nonadherence to the protocol was defined as too low or too high doses of potassium compared with the recommended potassium replacement protocol. Results The median duration of DKA treatment was longer in the nonadherent group than in the adherent group: 37 hours (interquartile range [IQR], 27-48) and 30 hours (IQR, 17-43), respectively (P = 0.005). Treatment duration correlated positively with nonadherence to potassium replacement protocol (r = 0.18; P = 0.005) and severity of DKA (r = 0.52; P <0.0001). Stepwise multivariate linear regression analysis indicated nonadherence to the protocol (ß = 0.14; P = 0.02) and severity of DKA (ß = 0.43; P <0.0001) as predictors of treatment duration, after adjustment for body mass index and age (R2 = 0.28; P <0.0001). Conclusions Nonadherence to potassium replacement protocol leads to prolongation of DKA management. Medical staff should be educated about the benefits of potassium replacement and precision in potassium administration and dosing in patients with DKA.

[Prevention of osteopenia in premature infants]. / Zapobieganie osteopenii u wczesniaków.

Proposition of recommendations for prevention of osteopenia in premature infants is presented in this article. In parenteral nutrition in premature infants calcium and phosphorus should be supplemented early in a dose of 80-100 mg/kg/24 h (2-2.5 mmol/kg/24 h) and 43-63 mg/kg/24 h (1.4-2 mmol/kg/24 h) respectively. In enteral nutrition calcium and phosphorus should be supplemented in a dose 90-150 mg/kg/24 h (2.25-3.7 mmol/kg/24 h), and: 45-80 mg/kg/24 h (1.5-2.6 mmol/kg) respectively. Breast milk fortifier is recommended up to the corrected age of 40 Hbd and in case of growth retarded infants - up to 52 Hbd. Vitamin D should be supplemented in a dose of 400-800 IU, particularly in breast fed infants. Vitamin content in formula or fortifier must be taken into account. Active metabolites of vitamin D are not recommended. Physical activities, together with appropriate mineral, protein and energy intake may decrease the risk of osteopenia. Laboratory assessment of calcium and phosphorus homeostasis is recommended every 2 weeks, from 6(th) week of life.

[Treatment of gastro-esophageal reflux in children and premature infants]. / Leczenie refluksu zoladkowo-przelykowego u dzieci i noworodków urodzonych przedwczesnie.

Gastroesophageal reflux is a common problem in the paediatric population, which affects especially infants, neonates and preterm infants. Usually the course is benign, but it can also be a cause of severe complications and acute life threatening events. In this paper diagnostic methods are presented and a systematic literature review of treatment options is given. Current recommendations are proposed according to the results of this review.