Diabetic ketoacidosis (DKA) is the most common emergency associated with acute hyperglycemia in patients with type 1 diabetes mellitus (T1DM) and is a major cause of morbidity and mortality in these patients. It is characterized by severe metabolic disturbances due to a lack of insulin and an increase in circulating counterregulatory hormones, gradually leading to acidosis and dehydration, eventually leading to coma and death if prompt and appropriate treatment is not received. [1, 3].
The diagnosis of DKA is based on hyperglycemia (blood glucose > 11 mmol/L or 200 mg/dL), ketosis (serum β-hydroxybutyric acid concentration > 3 mmol/L, or ketonuria ≥ 2+), and metabolic acidosis ( pH < 7.30 or serum HCO3- < 18 mmol/L), with varying degrees of hypovolemia [2,3,4].
The frequency of DKA at the onset of T1DM varies between approximately 15% and 70% in Europe and North America.The risk of DKA in patients already diagnosed with T1DM ranges from 1% to 10% per patient per year [2,3,4,5].
Fluid and electrolyte administration and insulin therapy are fundamental steps in DKA therapy. The goal is to correct acidosis, ketosis, and electrolyte imbalances, restore normal circulating volume and blood sugar levels, and avoid possible complications of DKA. [2,3,4]. In fact, DKA can lead to various complications if not managed properly and timely. Among them are hypokalemia and other electrolyte changes, hypoglycemia, and even more terrifying, cerebral edema, which in severe cases occurs in 0.3 to 0.9 percent of pediatric DKA cases. Cerebral edema is associated with high mortality (21-24%) and permanent neurological morbidity (20-26%) and is responsible for 70-80% of DKA deaths. [2,3,4]. Management of young her DKA patients should occur at a hub center with experience in pediatric DKA. If this is not possible, arrangements should be made to contact a doctor experienced in DKA. [3, 4, 6]. The initial evaluation of pediatric patients with DKA frequently occurs in the emergency department and may involve not only the pediatrician but also the emergency physician. Appropriate management of DKA is outlined by national and international recommendations. [3, 4, 7]. Appropriate application of guidelines in emergency situations is highly time-dependent and can be complex and error-prone due to the emotional burden and the different management of her DKA in children compared to adults. [2, 4, 8]. Nevertheless, only by strict adherence to DKA management guidelines can deviations and errors associated with poor clinical outcomes be reduced. [3, 6, 9].
For these reasons, simulation provides a valuable aid that allows us to practice standardized scenarios of complex real-world situations, encouraging immersion, reflection, feedback, and avoiding the risks that such situations pose. It aims to promote learning through practice.in fact [8, 10, 11]. This study tested the effectiveness of a standardized scenario that can be used to improve the recognition and treatment of pediatric DKA according to current international guidelines. [3].
