Endocrine Abstracts

Objectives: Diabetic ketoacidosis (DKA) remains a life-threatening emergency. An updated protocol was introduced in Sligo general hospital in 2009 to standardise DKA management. The aim of this study was to audit current practice against the protocol standards.

Methods: Clinical notes of all adult patients admitted with DKA between July 2009 and June 2012 were analysed and retrospectively audited against the protocol.

Results: Fifty-six episodes of DKA were identified in 36 patients. 57.1% (n=32) were males, and the median age was 28.5 years. 87.5% of episodes occurred in patients with type 1 diabetes (n=49). Infection was the main precipitating factor in 33 episodes (58.9%) followed by non compliance 19.6%, new onset diabetes 14.3%, and alcohol excess 7.1%. The majority of patients were managed in a general medical ward (58.4%, n=33), 25% (n=14) were managed in ICU, and nine patients (16.1%) in HDU. There were no deaths and the median length of stay was 4 days. Fluids were commenced within 60 min of arrival to ED in 91% (n=51) of episodes and the mean time to commence fluids was 30.3±3.6 min. Insulin was started within 60 min in 46 episodes (82.1%), with a mean time of 48.5±5.65 min. Potassium was inadequately replaced in 30.4% (n=17), and mild hypokalaemia (K⁺3.0–3.5) occurred in 10 episodes (17.9%). Long acting insulin was inappropriately stopped in 74.3% of admissions. The frequency of biochemistry and blood gas measurements followed the protocol in only 37.5 and 51.8% respectively. 93% (n=52) of admissions care were taken over by the diabetes team, and 89.3% (n=50) received education by the diabetes nurse pre discharge.

Conclusion: Although insulin and fluid replacements were generally in line with the recommendations, potassium replacement, continuing basal insulin, biochemistry and blood gas monitoring were inadequate. Emphasizing the importance of these parameters, especially to the junior doctors, is essential to improve care standards.