Paediatric Ketone Measurement and Intervention in Non-Diabetic Patients in Australasian Emergency Departments: A
Shannon E Trenwith1, Robert Millar2,3, Simon S Craig4,5,6
1Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Nurses and doctors in Australian and New Zealand emergency departments frequently screen non-diabetic children for elevated ketone levels. However, there are significant variations in how these levels are interpreted and managed.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Practice Variation
- Biochemical Monitoring
Background:
- Elevated ketone levels in non-diabetic children presenting to emergency departments (EDs) require careful assessment.
- Current practices for screening, monitoring, and treating these children vary significantly across healthcare providers.
Purpose of the Study:
- To evaluate the current self-reported practices regarding screening, monitoring, and treatment of elevated ketone levels in non-diabetic children.
- To identify future research priorities in this clinical area.
Main Methods:
- A voluntary electronic survey was distributed to healthcare professionals within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network.
- Respondents provided data on their self-reported practices, beliefs, and research priorities concerning elevated ketone levels.
Main Results:
- Responses were received from 423 nurses and 397 doctors across 28 Australian and New Zealand sites.
- Nurses were more likely to screen (90%) and monitor (66%) ketone levels compared to doctors (75% and 37%, respectively).
- Definitions of 'elevated' and 'severely elevated' ketone levels varied considerably between nurses and doctors, impacting management decisions, including fluid administration strategies.
Conclusions:
- Healthcare professionals in Australian and New Zealand EDs routinely screen non-diabetic children for elevated ketone levels.
- Significant discrepancies exist in the interpretation and management of elevated ketone levels, highlighting a need for standardized protocols and further research.
Objective:
To (i) assess variation in self-reported screening, monitoring and treatment of elevated ketone levels in non-diabetic children and (ii) establish future research priorities.
Methods:
Voluntary electronic survey of staff at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network-affiliated hospitals. Respondents provided information on self-reported practice, beliefs about screening, monitoring, and treating elevated blood ketone levels, and identified future research priorities.
Results:
Four hundred twenty-three nurses and 397 doctors from 28 sites across Australia and NZ contributed responses. Nurses were more likely than doctors to screen (90% vs. 75%) and monitor (66% vs. 37%) ketone levels. Greater than 24 h of vomiting or poor oral intake triggered respondents to check ketone levels (83% and 75% respectively). The definition of 'elevated' ketones varied considerably, with nurses' median 1 (IQR 0.7-2) mmol/L and doctors' median 2 (IQR 1-2) mmol/L. Similarly, 'severely elevated' ketones varied considerably, with nurses' median 3 (IQR 2-4) mmol/L and doctors' median 4 (IQR 3-5) mmol/L. 25% of respondents changed route of fluid administration in response to a severely elevated level, though only half of respondents provided a higher-glucose fluid. Sixty-seven percent of respondents supported further prospective observational research on the role of ketone screening and targeted therapies in children aged 6 months-6 years who fail an oral fluid trial.
Conclusions:
Nurses and doctors in Australia and NZ regularly screen for high ketone levels in non-diabetic children in ED, with significant differences in interpretation and management of 'elevated' levels.
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