A single centre audit on the management of diabetic ketoacidosis

Benai Paponette; Rayanna Maraj; Fashia Latiff; Hazheem Hussin; Azmark Azmark; Asmat Afridi; Muhammad Zeeshan Rashid; Elaine Soong; Shu Hoashi; Ultan Healy

doi:10.1530/endoabs.115.EP16

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Endocrine Abstracts (2026) 115 EP16 | DOI: 10.1530/endoabs.115.EP16

IES2025 Research, Audit and Quality Improvement Projects E-Posters (60 abstracts)

A single centre audit on the management of diabetic ketoacidosis

Benái Paponette , Rayanna Maraj , Fashia Latiff , Hazheem Hussin , Azmark Azmark , Asmat Afridi , Muhammad Zeeshan Rashid , Elaine Soong , Shu Hoashi & Ultan Healy

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Midland Regional Hospital Mullingar, Co. Westmeath, Ireland

The local Diabetic Ketoacidosis (DKA) Management Protocol in use at Regional Hospital Mullingar (RHM) is adapted from the 2013 Joint British Diabetes Society (JBDS) guidelines. The JBDS guidelines were updated in 2023. In advance of updating our local protocol, we undertook an audit of all DKA cases managed at RHM in 2024. We created an audit tool with 75 pre-specified questions adapted from the JBDS guidelines. Forty (40) patients with a primary or secondary diagnosis of DKA in 2024 were identified through Hospital In-Patient Enquiry (HIPE). Data was collected from the medical records, including laboratory records. Data was maintained in an anonymised excel database. Thirty-one (31/40,77.5%) patients were commenced on the DKA protocol. However, only twenty-seven (27/40, 67.5%) patients met criteria for DKA. Common precipitating factors included infection (16/31, 52%) and missed insulin doses (11/31, 35%). Most patients commenced on intravenous fluids (28/31, 90%) and insulin (24/31, 77%) within 1 hour of diagnosis. All patients (31/31, 100%) were reviewed by Clinical Endocrinology service prior to discharge. However, measurement and documentation of capillary blood glucose 20/31, 64%), capillary ketones (23/31, 74%), serum potassium (8/31, 27%), and urine output (7/31, 23%) was suboptimal. Hypoglycaemia was common (4/31, 14.3%). Additional areas identified for improvement include timely conversion to Variable Rate Insulin Infusion upon resolution of DKA (18/31, 59%), and early referral to the Diabetes Clinical Nurse Specialists service (17/31, 56%). These data will provide a baseline for re-audit following the introduction of the updated DKA protocol, and associated educational drive, in Autumn 2025.