Endocrine Abstracts

Objectives: To evaluate the precipitants of diabetic ketoacidosis (DKA) and to audit its management in a busy District General Hospital following the introduction of local guidelines.

Methods: Data on all patients admitted with DKA between January 2003 and March 2004 were collected and analysed and clinical management was audited against the standards set in the guidelines.

Results: Seventy eight episodes were recorded in 70 patients. Median age of the group was 28.5 years and median duration of diabetes prior to presentation was 10 years. In 64.1 percent a previous history of DKA was identified. 61 percent had not attended a hospital diabetes clinic in the last year.

Infection was identified as the precipitant in 31 cases (39 percent), 80 per cent of these due to gastroenteritis. 8 cases (10 percent) were first presentation of Type 1 Diabetes and 22 cases (28 percent) were due to poor compliance.

Initiation of intravenous fluid replacement and insulin were delayed in 56 percent and 33 percent cases respectively. Intravenous fluid replacement was inadequate in 36 percent of cases and potassium was under-replaced in 64 percent of cases. Frequency of biochemical monitoring was inadequate in 34 percent of cases.

There was 1 death and 6 patients were initially managed in the intensive care unit. 61 percent of cases were referred to the diabetes specialist nurse or registrar. Median length of admission was 3 days. Ninety five percent of patients had diabetic clinic follow up arranged before discharge.

Conclusion: In a significant proportion of patients treatment was delayed, insufficient intravenous fluid and potassium were administered and monitoring was inadequate. Adherence to the guidelines should therefore be strongly encouraged. Infection and poor compliance were major precipitants and therefore increasing awareness of 'sick-day rules' and the importance of good compliance should be emphasised.