P-97: Evaluation of a diabetic ketoacidosis (DKA) protocol in a tertiary hospital in São Paulo - Brazil
K Caetano, L Baião, G Costa, R Biasi, A Costa-Riquetto, L Cudizio, N Souza, L E CalliariAbstract
Introduction
The high incidence of DKA in Brazil and the elevated morbidity risks involved evidence the need for effective management strategies. However, there are limited regional publications describing treatment protocols and results. In 2019, Santa Casa de São Paulo University Hospital implemented a new DKA treatment protocol based on the ISPAD recommendations.
Objectives
To evaluate the efficacy and safety of the DKA treatment protocol used at a tertiary hospital in São Paulo.
Methods
This was a retrospective observational study based on the review of medical records of patients diagnosed with DKA in our institution and treated according to the updated protocol between 2019 and 2024.
Results
We collected data from 50 DKA episodes from the pediatric ICU. The median age was 11.3 years, 54% female. Besides typical symptoms, abdominal pain and vomiting were the most common ones. Initial results showed a median pH of 7.14 (SD 0.13), blood glucose of 416 mg/dL (SD 108), bicarbonate of 10.6 mEq/L (SD 5.2), serum potassium of 4.7 mEq/L (SD 0.9), and sodium of 133.7 mEq/L (SD 4.9). Median ketonuria was 3+ (range: 1–4). Regarding the Glasgow Coma Scale, 3 patients scored 14, while 47 scored 15. The mean time to reach a blood glucose level of 250 mg/dL was 6.2 hours (SD 4.0), with an average decline rate of 52.3 mg/dL/h (SD 42.0). The mean time for pH correction to values above 7.3 was 12.7 hours (SD 8.8). Resolution of ketonuria occurred at a mean of 18 hours (SD 9.5). The median protocol duration was 18.4 hours (SD 9.7). The mean fluid replacement volume was 3.7 liters (SD 2.3). Hypoglycemia occurred in 8% of patients, while hypokalemia was observed in 14%. Bicarbonate therapy was required in 10% of cases. No cases of death or cerebral edema were reported.
Conclusions
The DKA treatment protocol used at our institution proved effective and safe and may serve as a reference for emergency and pediatric intensive care settings in other pediatric hospitals in the country.