Endocrine Abstracts

Aim: To study trends in presentation and management of diabetic ketoacidosis (DKA) at a rural referral centre, to ultimately assist with development of a formal management protocol.

Methods: A retrospective audit of medical records for all presentations of DKA over a two year period was conducted to source age of patient, distance from Orange Health Service, new onset vs known type 1 diabetes mellitus, initial pH, time to normalisation of ketones, any episodes of hypokalaemia or clinically significant hypotension during their management, episodes of hyperchloraemia, and overall length of stay. Statistical analysis was carried out to determine the mean and S.D., where data was normally distributed, and the median when data was not normally distributed. Furthermore, Spearman’s correlations were conducted to examine the relationship between distance and age, length of stay and initial pH.

Results: 23 cases met the inclusion criteria for analysis. The mean age of patients was 25 years. (S.D. 8.1 years). The mean length of stay was 4.57 days (S.D. of 3.34 days). Complications were recorded in half of patients with complete data sets. The mean initial pH was 7.134 with a S.D. of 0.144. There was a statistically significant positive association between age and length of stay (rs=0.44, n=23, P<0.05) and a statistically significant negative association between length of stay and initial pH (rs=−0.51, n=23, P<0.05). Distance was not correlated with length of stay nor initial pH.

Conclusions: A significant proportion of patients have a severe presentation, and many patients are transferred from outlying facilities. These factors need to be considered when planning service delivery and have been considered when developing a formal protocol appropriate for a major rural referral centre.