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J Clin Res Pediatr Endocrinol. 2019 Nov 14. doi: 10.4274/jcrpe.galenos.2019.2019.0121. [Epub ahead of print]

The Effects of Prehospital Care on Outcome in Pediatric Diabetic Ketoacidosis

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Department of Pediatrics, Division of Pediatric Emergency, Ege University School of Medicine, Izmir, Turkey
Department of Pediatrics, Ege University School of Medicine, Izmir, Turkey
Department of Pediatrics, Division of Pediatric Endocrinology, Ege University School of Medicine, Izmir, Turkey



Despite the guidelines, significant variations can be encountered on initial therapy for pediatric diabetic ketoacidosis (DKA) in the prehospital setting. These variations mostly on fluid administration, insulin dosing, route of administration, and other aspects of the initial resuscitation and stabilization. We aimed to identify the effect of transport care on outcomes in children with DKA admitted to the ED.


Patients admitted to the tertiary-care-pediatric-ED between 2015-2019 with a diagnosis of DKA were retrospectively identified. The pre–pediatric ED care including transport modality, patient demographics, clinical features, laboratory evaluation, fluid therapy, insulin dosing, and the short-term outcome recorded.


The study cohort included 147 episodes of DKA in 136 patients (9 months-21 years). Emergency Medical Service (EMS) transported only one-third episodes (37.4%). EMS utilization rate was significantly higher in severe cases and most of them were >10 years (p=0.003, p=0.04). Eighty-five percent received intravenous fluid bolus during the transport. Fluids other than normal saline use was significantly higher when the transport time lasted >30 minutes (p=0.001). Acute kidney injury and cerebral edema developed in 21.7% and 7.4 % of episodes, respectively. These complications more likely developed in EMS transported group. Pediatric intensive care unit admission rate was also higher in EMS when compared to non-EMS group (p=0.01).


Parents were not likely to call the ambulance for most cases, the higher complication rate occurred in EMS patients. EMS providers and referral facilities should improve their knowledge of pediatric DKA.


Diabetic ketoacidosis; prehospital care; diabetes mellitus; insulin; pediatric transport

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