Aim To evaluate the management and outcome of children with severe DKA who were referred by different District General hospitals within the region to Regional retrieval team for advice.

Method Retrospective audit of all patients with diagnosis of DKA, referred to Regional Retrieval Team between November 2010 – June 2012 were included in the audit. Data was collected via the RRT database and Retrieval referral forms.

Results Over twenty months NWTS received 1637 referrals from 29 District General Hospitals in the region out of which 20 patients (1.22%) were severe DKA. 6/20 were newly diagnosed DKA.

At time of referral 10/20 were noted to have significantly reduced GCS, requiring hypertonic saline and an urgent CT scan.

Following advice from NWTS, only 7 were transferred to PICU and rest were managed in their local DGH; each followed up for a period of 24 – 48 hours with minimum of two follow-up calls.

3 out of 7 transferred to PICU had very low level of consciousness (GCS 3–4/15); the rest had intercurrent illness e.g. sepsis, myocarditis and non availability of HDU beds.

All patients survived and only one patient (who also had problems with severe tachyarrhythmia and associated poor cardiac output) had evidence of neurological injury.

Conclusion With advice and support the local DGH team can be guided through the management of severe DKA including those with reduced GCS, with good outcome.

The DGH clinicians value the support available from Regional Retrieval Team as many are unfamiliar with management of such rare situations.

The majority of patients did not require transfer to tertiary centres which benefited both the patient and family and allows best utilisation of resources.