MMPAD Milan Meeting Report

8 European Roadshow - Milan, 29 June 2018 MEETING REPORT DIABETIC KETOACIDOSIS Presented by Dr. Riccardo Bonfanti - San Raffaele Hospital, Milan Epidemiology and diagnosis Diabetic ketoacidosis (DKA) is defined, according to the ISPAD 2014 guidelines, as: 7 • hyperglycaemia (> 200 mg/dL) • venous pH <7.3 or HCO3- <15 mmol/L • ketonaemia >3 mmol/L • presence of glycosuria and ketonuria. It may be mild (pH <7.3 or HCO3- <15 mmol/L), moderate (pH <7.2 or HCO3- <10 mmol/L) or severe (pH <7.1 or HCO3- <5 mmol/L). When DKA starts there is a spontaneous or induced reduction of insulin, which causes hyperglycaemia, ketonaemia, polyuria and polydipsia, dehydration and metabolic acidosis. The epidemiology of DKA recognises a wide geographical variability – from 15 to 67% at onset and from 1 to 10% per year in diabetic patients; it has an inverse correlation with the incidence of diabetes. In Italy, the average incidence of DKA at the onset, for the period 2005-2012, is 40% and, despite the considerable work done to increase the sensitivity to the problem, it has not been possible to change it over time . 8, 9 In many cases the condition is not diagnosed, so it has been suggested that a capillary blood sugar test be imposed on all children in the emergency room. In fact, DKA mortality (about 1 case/year in Italy in the period 2004-2013) and morbidity at onset is relatively high, which may include electrolyte disturbances, hypoglycaemia, disseminated intravascular coagulation (CID) and acute respiratory distress syndrome (ARDS), chronic renal failure, acute pancreatitis and rhabdomyolysis . 10, 11 Neurological sequelae can also be important and permanent. If, as we have seen, it is difficult to prevent diabetes, DKA must be prevented. An extract from Dr. Bonfanti ‘s presentation is available here