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

Standardising care for diabetic ketoacidosis (DKA): are we meeting expectations? (#254)

Hong Lin Evelyn Tan 1 2 , Matthew Rowlandson 1 , Judy Luu 1 2 , Shamasunder Acharya 1 2
  1. Department of Endocrinology and Diabetes, John Hunter Hospital, New Lambton, NSW, Australia
  2. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

Introduction: Diabetic ketoacidosis(DKA) is a medical emergency with well-established principles for management. Despite this, an audit of DKA admissions to John Hunter Hospital(JHH) in 2010 revealed suboptimal management in most patients when measured against the Scottish National Standard. In response, a management protocol was introduced in 2012. 

Aims: To determine if the introduction of a management guideline has improved management of DKA.

Methods: A retrospective audit was conducted of adult DKA presentations to JHH over two 12-month periods before(year 2010) and after(year 2014) protocol implementation. Cases were identified from ICD-10 coding and records were manually reviewed. The Scottish National Standard for DKA was applied to cases to determine adequacy of treatment.

Results: During 2010 and 2014, there were 50 and 46 DKA presentations respectively. Most cases were in patients with Type 1 diabetes(90% in 2010 vs 93.5% in 2014). There was no difference in baseline HbA1c between the two years(10.9% vs 10.6%,p=0.65). The main precipitant for DKA was missed insulin doses(36% vs 28%).

35/46(76%) presentations in 2014 were managed with the protocol. Compared to 2010, there were significantly more patients in 2014 commenced on IV insulin within 2hr of arrival(42% vs 68.6%,p=0.027). A trend towards earlier blood gas measurement within 1hr was observed(72% vs 89%,p=0.10), with no difference in initiation of IV fluid(64% vs 66%,p=1.0). There was a trend towards less hypokalaemia(<3.5mmol/l) during first 24 hours of admission(38% vs 22.9%,p=0.162). There was no difference in length of stay(median 2 days).

Analysis of sample mean variations will be reported.

Conclusions: Insulin omission remains the primary trigger for DKA in our population. The introduction of a management protocol for DKA was associated with earlier inititation of insulin treatment but no difference in length of stay. There were non-significant trends to earlier performance of arterial blood gas and less hypokalemia in the first 24 hours of treatment.