MMPAD Munich Meeting Report

MEETING REPORT 8 European Roadshow - Friday 25 th May, 2018 Munich, Germany Insulin infusion should take place with standard insulin. So far injections of 0.1 units of insulin per kilogram of body weight per hour (0.05 U/kg per h in children 0–6 years of age) for DKA treatment have been recommended. 6 Data from the recent FLUID study, however, indicate that a lower intravenous insulin therapy (0.03 and 0.05 U/kg per h) also effectively lowers BOHB levels . 7 A possible reduction of intravenous insulin dosages is welcome because potassium fluctuations (hypokalaemia) will be less pronounced. Intravenous insulin substitution should start 60 to 120 minutes after initiation of intravenous rehydration. In addition, possible complications of DKA must be detected and treated. The first 12 hours are crucial for the development of brain oedema (risk factors: being unaware of diabetes, young age, persistent clinical signs) . 2, 8 To treat brain oedema, fluid substitution should be reduced to 65%. In addition, mannitol (0.5–1.0 g/kg within 20 minutes, maximum one repetition) and 3% hypertonic saline solution (5 mL/kg within 30 minutes) can be administered (raise head by 30% in the medial position, intubation if needed and imaging if stable). Renal complications include prerenal insufficiency. Risk factors for recurrent DKA include omitting insulin dosages, poor metabolic control, previous DKA episodes, gastroenteritis with persistent vomiting and the inability to maintain fluid balance, psychiatric disease, dysfunctional families (abuse), (pre-) puberty and alcohol abuse, as well as limited access to medical care . 2 How to prevent DKA? According to Raile, patient education and public relations are useful tools to increase awareness of type 1 diabetes-associated complications in the general population, as well as among medical professionals. He stressed that identifying and treating patients with type 1 pre-diabetes, monitoring of ketones in the peripheral blood as well as 24/7 support for families are all practical preventive measures to avoid DKA. His take-home messages included: • DKA in children and adolescents is a metabolic derailment caused by an absolute or relative lack of the anabolic hormone insulin. • Brain oedema is the main complication, leading to increased morbidity and mortality of children with diabetes. • The now completed PECARN-FLUID- study (PECARN: Pediatric Emergency Care Applied Research Network; FLUID: Fluid Therapies Under Investigation in DKA) shows that rapid as well as slower substitution and rehydration with full electrolyte or half electrolyte solutions are equally effective. Thus centre-specific standards have become relatively flexible.