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Abstract：
BACKGROUND: The aim of this study is to assess the adherence of Austrian physicians to International Society for Pediatric and Adolescent Diabetes guidelines 2009 concerning treatment in diabetic ketoacidosis and whether there is a difference between specialty (endocrinologists or intensivists) or clinical experience.
METHODS: An online questionnaire was sent to members of the working groups of the Austrian Society of Pediatric and Adolescent Medicine.
RESULTS: Of 106 questionnaires, 56 were included in the analysis. The mean ± SD overall adherence was 60 ± 23.5%. Endocrinologists showed a nonsignificant higher result, related to a significant higher adherence regarding the amount of fluids (P < 0.05) and tendency to bicarbonate use (P = 0.052) respectively. No differences were found between participants with different clinical experience. All gave crystalloids, 55% administered initial bolus of 10 to 20 mL/kg per hour, 58% used 1.5 to 2 times fluid maintenance, 87% started insulin after first fluid bolus, 28% gave 0.05 and 0.1 IE/kg per hour to infants and children respectively, and 43% 0.05 IE/kg per hour to all patients. When blood glucose falls, 53% gave glucose and 47% reduced insulin. In cerebral edema, 46% gave at least 2 of 3 recommended measures (fluid reduction, mannitol, or hypertonic saline). In acidosis (pH <6.9), 25% administered bicarbonate (as per guideline) and 52.9% never gave bicarbonate.
CONCLUSIONS: Adherence to the actual guidelines is 60% and does neither depend on speciality nor on clinical routine. Essential treatment measures (eg, amount of fluids, consequence of rapid glucose fall, bicarbonate use) are not commonly known.
METHODS: An online questionnaire was sent to members of the working groups of the Austrian Society of Pediatric and Adolescent Medicine.
RESULTS: Of 106 questionnaires, 56 were included in the analysis. The mean ± SD overall adherence was 60 ± 23.5%. Endocrinologists showed a nonsignificant higher result, related to a significant higher adherence regarding the amount of fluids (P < 0.05) and tendency to bicarbonate use (P = 0.052) respectively. No differences were found between participants with different clinical experience. All gave crystalloids, 55% administered initial bolus of 10 to 20 mL/kg per hour, 58% used 1.5 to 2 times fluid maintenance, 87% started insulin after first fluid bolus, 28% gave 0.05 and 0.1 IE/kg per hour to infants and children respectively, and 43% 0.05 IE/kg per hour to all patients. When blood glucose falls, 53% gave glucose and 47% reduced insulin. In cerebral edema, 46% gave at least 2 of 3 recommended measures (fluid reduction, mannitol, or hypertonic saline). In acidosis (pH <6.9), 25% administered bicarbonate (as per guideline) and 52.9% never gave bicarbonate.
CONCLUSIONS: Adherence to the actual guidelines is 60% and does neither depend on speciality nor on clinical routine. Essential treatment measures (eg, amount of fluids, consequence of rapid glucose fall, bicarbonate use) are not commonly known.
摘要：
背景：这项研究的目的是评估奥地利医师对2009年国际儿科和青少年糖尿病学会关于糖尿病酮症酸中毒治疗的指南的依从性，以及专业（内分泌学家或重症医师）或临床经验之间是否存在差异。
方法：向奥地利儿科和青少年医学学会工作组成员发送了一份在线调查问卷。
结果：在106份问卷中，56个被包括在分析中。平均±SD总体依从性为60±23.5%。内分泌科医生显示了一个不显著的更高的结果，分别与液体量（P<0.05）和碳酸氢盐使用趋势（P=0.052）的显着较高的依从性有关。在具有不同临床经验的参与者之间没有发现差异。都给了晶体，55％的初始推注剂量为每小时10至20mL/kg，58%使用1.5至2次流体维护，87%在第一次液体推注后开始胰岛素，28％的婴儿和儿童每小时分别给予0.05和0.1IE/kg，和43％0.05IE/kg每小时对所有患者。当血糖下降时，53%给予葡萄糖和47%减少胰岛素。在脑水肿中，46%的人至少给出了3种推荐措施中的2种(减少液体，甘露醇,或高渗盐水)。酸中毒（pH<6.9），25%的人服用碳酸氢盐（根据指南），52.9%的人从未服用碳酸氢盐。
结论：对实际指南的依从性为60％，既不依赖于专业，也不依赖于临床常规。基本治疗措施(如，液体量,葡萄糖快速下降的结果，碳酸氢盐的使用)并不常见。
方法：向奥地利儿科和青少年医学学会工作组成员发送了一份在线调查问卷。
结果：在106份问卷中，56个被包括在分析中。平均±SD总体依从性为60±23.5%。内分泌科医生显示了一个不显著的更高的结果，分别与液体量（P<0.05）和碳酸氢盐使用趋势（P=0.052）的显着较高的依从性有关。在具有不同临床经验的参与者之间没有发现差异。都给了晶体，55％的初始推注剂量为每小时10至20mL/kg，58%使用1.5至2次流体维护，87%在第一次液体推注后开始胰岛素，28％的婴儿和儿童每小时分别给予0.05和0.1IE/kg，和43％0.05IE/kg每小时对所有患者。当血糖下降时，53%给予葡萄糖和47%减少胰岛素。在脑水肿中，46%的人至少给出了3种推荐措施中的2种(减少液体，甘露醇,或高渗盐水)。酸中毒（pH<6.9），25%的人服用碳酸氢盐（根据指南），52.9%的人从未服用碳酸氢盐。
结论：对实际指南的依从性为60％，既不依赖于专业，也不依赖于临床常规。基本治疗措施(如，液体量,葡萄糖快速下降的结果，碳酸氢盐的使用)并不常见。
