Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Review of Diabetic Ketoacidosis admissions at Fiona Stanley Hospital in Western Australia (#266)

Kyaw Thura 1 , Benjamin Massam 2 , Nick Lan 1 , Kerry Fitzsimons 3 , Bu B. Yeap 1 2 , P. Gerry Fegan 1
  1. Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals Group, Perth , WA , Australia
  2. School of Medicine , University of Western Australia , Perth , WA , Australia
  3. Pharmacy Department , Fiona Stanley Hospital, Perth , WA , Australia

Background

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes with an increasing incidence of hospitalisation.1 Fiona Stanley Hospital (FSH) opened to admissions January 2015 with a DKA treatment policy based on the JBDS guideline.2

Aim

Describe the characteristics and outcomes of patients admitted with DKA.

Methods

Patients admitted to Fiona Stanley Hospital (FSH) and treated for DKA 1st January to 31st December 2015 were retrospectively identified via clinical coding and confirmed by electronic medical record review.

Results

There were 101 DKA admissions in 70 patients. Mean (±SD) age 36.8±20.3 year, median diabetes duration 9.0 years and HbA1c 10.7%. 31.7% met criteria for severe DKA. 17.8% developed DKA whilst an inpatient. Main precipitants of DKA included non-compliance (39.6%), infection (24%), alcohol/illicit drug use (7.1%) and newly diagnosed T1DM (6.25%). At presentation, mean (±SD) glucose 27.4±12.34mmol/l, pH 7.18±0.17, bicarbonate 12.4±6.23mmol/L and blood ketones 6.2±4.8mmol/l. 58.4% of patient’s fluid and potassium (K+) management adhered to protocol. Prescription of basal insulin at outset was 57.1%. Median time to resolution of ketosis was 10 [7-14.5] hours and acidosis 10 [5-17] hours. Hypokalaemia (K+<3.5mmol/L) occurred in 32.7%. Median length of stay (LoS) was 1.9 days (IQR 2.1days) with shorter LoS being associated with earlier review time by an endocrinologist (p=0.002), younger age (p=0.002) and normokalaemia at diagnosis (p=0.029). 83.2% of patients had specialist outpatient follow-up scheduled and 25.7% were readmitted during the study period. Attendance at specialist clinics was associated with a lower rate of readmission (p=0.041).

Conclusion

Utilisation of a contemporary fixed rate insulin infusion protocol demonstrated relatively shorter LoS and lower risk of hypokalaemia compared to conventional protocols. Prospective studies are warranted to determine whether improving adherence to the protocol and facilitating specialist review would improve DKA outcomes.

 

  1. Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand. Venkatesh et al. Critical Care 2015; 19:451
  2. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Savage et al. Diabet Med. 2011; 28:508-15.