Question: Why do we have a mandatory patch point for pediatric patients (> 2 but less than 12) with a blood sugar over 25 mmol/l and suspected to be in DKA for a fluid bolus but there is no patch point for adult patients.
Great question. This has been asked previously on Jan 31, 2012. A Mandatory Provincial Patch Point is only required to administer a fluid bolus to a patient greater or equal to 2yo and less than 12yo. The rationale here is that volume overload and a rapid decline in serum blood glucose levels can lead to cerebral edema in this paediatric patient population. This serious complication is much less likely to occur in adults who often are significantly more dehydrated and/or can tolerate greater volumes of IV fluid, certainly the amount that can most commonly be administered in the pre-hospital setting.
The background to this decision however also includes that out of a coroner's inquest, a care map was created for emergency departments to manage cases of suspected DKA in children. This was then sent to the BH Provincial MAC to be incorporated into a Medical Directive. Unfortunately, many of the indications listed for fluid bolus on this care map cited references to abnormal lab values or arterial blood gas determinations which are not available pre-hospital or fall outside the paramedic scope of practice. Therefore, it was felt by the MAC that the burden and liability of the decision to administer IV fluid to this vulnerable patient population should not rest with the paramedic but with the BH physician; thus the Mandatory Provincial Patch Point