MMPAD Milan Meeting Report

9 European Roadshow - Milan, 29 June 2018 MEETING REPORT Reflection: Key messages for DKA management In the presence of a suspected DKA diagnosis, it is necessary to send the patient to specialised centres that are able to manage the situation. The key recommendations for the management of DKA are : 11 • modest rehydration (0.9% physiological solution, at a rate of 5-10 mL/kg/h), with careful monitoring of electrolytes (and not of blood sugar) • modest amount of insulin for a slow glucose correction (no bolus) • no bicarbonates • monitor the patient attentively and pay particular attention to cardiovascular data • monitor the possible occurrence of cerebral oedema. Cerebral oedema is the most frequent cause of mortality and morbidity in DKA, with a prevalence of 0.3-1%, and is particularly common in preschool children. The diagnostic criteria are shown in the table below. Reflection: Criteria for the diagnosis of cerebral edema in diabetic ketoacidosis (Rabbone et al., Acta Biomedica 2015 ) 11 DIAGNOSTIC CRITERIA MAJOR CRITERIA MINOR CRITERIA Abnormal motor or verbal response to pain Altered state of consciousness Vomiting Decorticate or decerebrate posturing Reduced heart rate (<20 beats / minute) Cephalalgia Paralysis of cranial nerves (especially III, IV and VI) Incontinence Lethargic state Disturbed breathing (wheezing, tachypnea, Cheyne-Stokes breathing) Diastolic pressure > 90 mmHg Apnoea Age < 5 years The diagnosis, with 92% sensitivity and 96% specificity, is made by the presence of 1 diagnostic criterion or 2 major criteria or 1 major criterion and 1 minor criterion.