Aim To evaluate the blood gas and blood ketone abnormalities in children requiring intravenous fluids for management of gastroenteritis. Background Gastroenteritis commonly presents to acute paediatric services. Most children are successfully managed with oral rehydration therapy (ORT). However, some children will need intravenous (IV) fluids either due to failure of ORT or persistent vomiting. Ketones are produced by metabolising fat as an alternate energy source in place of carbohydrates. It is known that raised ketone levels in conditions like diabetic ketoacidosis can contribute to nausea and vomiting. Method There are two parts to this study. The first part is a retrospective observational study of children with gastroenteritis comparing 69 children requiring IV fluids to 87 children treated with ORT. The second part is a prospective study involving 32 children with gastroenteritis who required IV fluids. Blood sample was taken for blood gas and beta hydroxybutyrate (BOHB) levels while obtaining venous access. Treatment was carried out according to clinical requirements as per guidelines irrespective of the blood BOHB level. Results Both data sets had similar demographics of gender, age and weight centile. The retrospective data showed those on IV fluids compared to ORT were more acidotic (p < 0.001) with a raised anion gap (p = 0.0014). The observational data demonstrated that BOHB levels prior to IV fluid therapy were normal (<0.6) in 5 patients, mildly raised (0.6–1.5) in 5, moderately raised (1.6–3) in 7 and high (>3) in 15. Following a period of IV fluids there was a reduction in acidosis (p = 0.0034) and BOHB levels (p = 0.0026). Conclusion The majority of children with gastroenteritis who require IV fluids have a metabolic acidosis, raised anion gap and significantly raised BOHB levels. The study also illustrated a significant reduction in acidosis and BOHB with fluid management. Taking a blood gas and ketone level in children with vomiting as predominant symptom may aid in making an early decision about the need for IV fluid therapy. Using IV fluids may also ease nausea and vomiting by reducing the ketosis and acidosis in dehydrated children.
Aims To collect information about patients experience of their transition from paediatric to young adult services To receive feedback from staff involved in the care of patients transferring from paediatric to adult care. To obtain baseline information on the specific processes currently in place at this trust for diabetic patients transferring from paediatric to adult care based on the recommendations set out by Diabetes UK and local standards. Methodology Two survey forms were designed, one for the staff and the other for the patients to complete. In addition, baseline data on the processes currently in place for transition of patients from paediatric to adult services was collected by retrospective case notes and electronic database review. 49 patients were identified for the audit data. Survey forms were sent to all the patients. Staff survey forms were distributed to staff involved in diabetes transition. Results 62% of patients were transferred to adult services at 17 years of age. 47% of cases transition took place at a time of relative stability and coordinated with other life transitions. 98% of cases were transferred into a dedicated adolescent clinic run jointly by paediatric and adult staff. In only 13% of the cases, a clinical psychologist was involved in the transition process. Only 27% of cases written information was provided about transition process and transition clinic. Less than 56% of patients were provided with written information about career, socialising and vocational issues. Only 40% of patients felt the age of transfer to adult services was appropriate, remaining felt it should be later Only 33% of staff felt that patients educational needs are met. Conclusion Vast majority of the patients are being transferred through a dedicated adolescent clinic. There is a lack of written information about transition process, transition clinic as well as information about career, socialising and vocational issues. There is a need to actively involve the patient and family in transition process to ensure transition takes place at an appropriate age coordinated with other life transition.
Aim To understand the difference in presentation of an inherited condition depending on the mode of inheritance. Case Report Case A: 11 years old girl with history of tiredness, normal BMI, had high blood glucose BG (7.1 mmol/L) and HbA1c (45 mmol/mol). There was family history of Type 2 Diabetes mellitus (DM) in mother, diagnosed at age of 23 years.
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