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This is a strong clinical audit/observational abstract with a clear case anchor and a useful safety message. The main improvement needed is clarity, structure, and tightening of the message for conference submission.
Below is a polished version that preserves your content but improves flow, academic tone, and readability:
When Diabetic Ketoacidosis Strikes Early: Cardiac Complications in Infants and Toddlers — An Observational Study in a District Hospital
Presenting Author: Lucy Davies
All Authors: Jamie Caswell¹, Lucy Davies², Anshoo Dhelaria², Kanimozhi Tamilselvan², Nicola Birchmore³, Catherine Peters³, Cristina Matei²
¹East and North Hertfordshire NHS Trust
²East and North Hertfordshire NHS Trust
³Great Ormond Street Hospital
1. Why did we do this work?
Diabetic ketoacidosis (DKA) in children under 4 years is rare but associated with increased severity and risk of complications. Retrieval teams are often involved late, when children are critically unwell, despite the potential benefit of earlier escalation.
Following a case of severe DKA complicated by myocardial dysfunction in a toddler, we reviewed all children under 4 years presenting with DKA to our district general hospital. We aimed to assess severity, complications, biochemical abnormalities, and retrieval team involvement, with a focus on early recognition of cardiac dysfunction in this vulnerable group.
2. What did we do?
We report a sentinel case of a 19-month-old child presenting with severe DKA (pH 6.81, glucose 27 mmol/L, ketones high) who initially responded to standard treatment but deteriorated after 36 hours with respiratory distress, tachycardia, oliguria, and pulmonary oedema.
Despite initial metabolic improvement, the child developed worsening lactataemia, hypophosphataemia, and signs of cardiogenic shock. Echocardiography confirmed severe biventricular dysfunction, requiring transfer to a cardiac PICU for inotropic support.
We then performed a retrospective review of all children under 4 years diagnosed with new-onset type 1 diabetes over a 28-month period.
3. What did we find?
Between March 2023 and July 2025, 55 children were diagnosed with new-onset type 1 diabetes. Twelve were under 4 years of age, including four diagnosed before their second birthday (15–19 months).
Three of the four infants presented in severe DKA (pH <7.1)
Median length of stay was 2 days
One child (our index case) required PICU retrieval due to cardiac dysfunction
Only one case had early retrieval team involvement
Two cases were initially misdiagnosed as respiratory illness prior to blood gas confirmation
Phosphate and magnesium were not routinely monitored in most cases
4. What does it mean?
This series highlights the vulnerability of infants and toddlers with DKA to rapid clinical deterioration and cardiac dysfunction.
Myocardial impairment is likely multifactorial, related to prolonged acidosis and electrolyte derangements. Hypophosphataemia may reduce myocardial contractility via impaired ATP and 2,3-DPG production¹, while hyperchloraemia may contribute to vasodilation and reduced cardiac responsiveness².
Current BSPED guidance recommends balanced crystalloids such as Plasmalyte over 0.9% saline in severe DKA³, which may mitigate some of these effects.
Our findings support:
Early consideration of cardiac dysfunction in young children with severe DKA
Earlier involvement of retrieval/tertiary services
Routine monitoring of phosphate and magnesium
Low threshold for echocardiography in persistent acidosis or haemodynamic instability
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