medical director picu Denver Health Medical Center Denver, Colorado, United States
Background: Diabetic ketoacidosis (DKA) represents a life-threatening complication of diabetes mellitus in both pediatric and adult populations. Children differ from adults by delayed recognition of initial diagnosis, higher basal metabolic rate, and less developed cerebral autoregulatory mechanisms. These complications led to judicious fluid administration within pediatric clinical protocols while many adult protocols suggest higher rates and greater total volume of fluid administration. This study offers novel insights into comparing treatment outcomes and complications between adolescents and young adults treated with either a pediatric or adult protocol in the intensive care setting at Denver Health Hospital Authority. Objective: Based on the differences between these protocols, we hypothesize patients (19 years and above) treated with the adult protocol receive a greater volume of fluids and insulin than those treated with the pediatric protocol (ages 12-19 years). These differences may lead to a higher incidence of complications for young adult patients, as well as a faster correction time and shorter ICU stay for those treated with the adult protocol. Protocols designed specifically for this age range could offer improved clinical outcomes and reduced resource utilization. Design/Methods: This cohort study included patients ages 12-25 treated for DKA in the pediatric and adult intensive care settings at Denver Health between 2014 and 2019. A retrospective chart review evaluated adverse events such as cerebral edema and electrolyte abnormalities while measuring total fluid administration and various fluid types. We used the length of ED and ICU stay, time to correct bicarbonate to 17 or above, and electrolyte correction to assess resource utilization. Information from the electronic medical record was recorded in RedCap (a secure data collection software tool) in a password-protected fashion, and data was analyzed and reported in a de-identified form. This study was approved by the University of Colorado IRB with plans to finish data analysis and statistics in three months.
