Sara Soshnick, DO, MS
Attending Physician, Pediatric Critical Care
Children's Hospital At Montefiore
Bronx, New York, United States
Disclosure information not submitted.
Courtney Caminiti, MD, MPH
Pediatric Resident
Children's Hospital at Montefiore, United States
Disclosure information not submitted.
Lisa Underland, DO, MS
Assistant Professor of Pediatrics
Children's Hospital at Montefiore, United States
Disclosure information not submitted.
Ilir Agalliu, MD, ScD
Associate Professor
Albert Einstein College of Medicine, United States
Disclosure information not submitted.
Henry Ushay, MD, PhD, FCCM
Medical Director, Pediatric Critical Care Unit, Interim Division Chief
Children's Hospital at Montefiore
Bronx, NY
Disclosure information not submitted.
Chhavi Katyal, MBA, MD, MS
Associate Professor of Pediatrics
Children's Hospital At Montefiore, United States
Disclosure information not submitted.
Title: Outcomes in Pediatric Diabetic Ketoacidosis When Treated in the Intensive Care Unit vs Floor
Introduction: Pediatric Diabetic Ketoacidosis (DKA) causes significant physiologic derangements requiring aggressive therapy and close monitoring. Care is often undertaken in the Pediatric Intensive Care Unit (PICU), but severe complications are rare and patients often respond quickly to therapy. At our institution a recent policy change (8/1/2020) shifted care of mild-moderate DKA from the hospital floors to the PICU. We aim to compare outcomes before and after this change.
Methods: Retrospective observational cohort study of DKA patients under 21 years admitted to the Children’s Hospital at Montefiore from 1/1/2018-8/1/2021. Patients were identified by electronic medical record review. Mild-moderate DKA was defined by presence of ketoacids, hyperglycemia, serum pH < 7.3 but >7.1 and bicarbonate < 15 but >5. All patients were treated per standard DKA protocol. Data are expressed as medians with interquartile ranges. Mann Whitney U and Chi Square tests were used to test significance.
Results: 69 patients (34 floor, 35 PICU) underwent preliminary analysis. There was no difference in age, sex, prior diabetes diagnosis, or presenting serum pH and bicarbonate between groups, and no severe complications. Total length of stay (LOS) was similar for PICU (51.5 hours, [34.8-117.3]) vs floor (47.5 hours, [39.5-72.3]), p=0.07. Time to DKA resolution (12 hours [9-18.5] vs 10.5 [6.3-13.5], p< 0.03) and duration of insulin drip (14 hours [10-21] vs 11 [9-14], P< 0.02) were longer for PICU vs floor, while time from DKA resolution to first subcutaneous insulin dose was shorter in the PICU (130 minutes [60-277.5] vs 168.5 [78.3-303.5], p< 0.01). Intravenous electrolyte repletion occurred much more frequently in the PICU (p< 0.01), with a corresponding decrease in electrolyte abnormality on final chemistry (p=0.02). There was no difference between groups in significant deviation from DKA protocol (p=0.14) or gap in lab monitoring >3 hours (p=0.12).
Conclusions: Preliminary analysis suggests shifting care of mild-moderate pediatric DKA to the ICU did not improve hospital LOS and was associated with longer duration of DKA and insulin infusion. Lab monitoring interval and protocol adherence was similar; however, PICU electrolyte management was more aggressive and lead to fewer patients with electrolyte abnormality at discharge.