The effect of infusion therapy in the framework of prehospital care on the duration of diabetic ketoacidosis in a children’s hospital

In children and adolescents with type 1 diabetes mellitus (DM), diabetic ketoacidosis (DKA) represents an acute and severe complication with a high risk of further complications and death. DKA is a grave condition that requires the hospitalization of a child into an intensive care unit. The quality of prehospital emergency care for DKA in pediatric practice is a pressing issue. Aim: to assess the impact of infusion therapy at the stage of prehospital care on the duration of hospital DKA treatment in children and adolescents. Methods. The study involved 104 children with DKA (60 boys and 44 girls with a mean age of 8.4±0.98 years) receiving treatment in an intensive care unit. Based on the volume of care received during the prehospital stage, two study groups were formed, namely, group I (n=52) — fluid resuscitation; and group II (n=52) — receiving no medication. At their admission to the clinic, patients underwent testing to assess the levels of their blood glucose and glycated hemoglobin (HbA1c), as well as urinary ketone bodies, had their level of consciousness estimated using the Glasgow Coma Scale, and severity of their DKA evaluated. Once the symptoms of DKA were resolved, the patient›s duration of hospital treatment was recorded. Statistical assessment of data involved the use of the Mann–Whitney test. Results and discussion. Group I children, who had received the fluid resuscitation during their prehospital care period, spent significantly less time undergoing hospital DKA treatment (p=0.0000) and had the lowest blood glucose (р=0.0001) and HbA1c (p=0.0000) levels. Children from group II, who had not received any medicaments at the prehospital stage, had the highest prevalence of DKA graded as severe. Fluid management at the prehospital stage are well-justified tactical interventions that reduce the duration of hospital DKA treatment of children and adolescents. Conclusion. Combining fluid management as part of prehospital care of children with DKA is the most efficient method for decreasing the clinical manifestations and complications of DKA during hospital treatment.

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