Endocrine Abstracts

Diabetic Ketoacidosis (DKA) is a life threatening emergency and its management is frequently protocolised. Adherence to protocols has been shown to shorten the time to DKA resolution however the management recommendations outlined in most DKA protocols is based on weak evidence and/or consensus. The aim of this study was to evaluate the frequency with which divergence from local DKA protocol was observed at our institution. A retrospective review of medical records was conducted of adults presenting with DKA to our institution over a three month period. Data collected included intravenous fluid (IVF), insulin and potassium requirements based on the protocol as well as intravenous fluid, insulin and potassium prescribed and administered to individual patients. A total of ten DKA patients were identified and included in this study. The mean±SD of hours patients spent on the DKA protocol was 9.3±3.9 hours. A mean±SD volume of IVF of 4.4±2.1L was required as per the protocol however 50% of patients were prescribed IVF in excess of that recommended. A fixed rate insulin infusion was prescribed in all patients. 40% of patients received a lower dose of insulin than was specified in the protocol. Although basal insulin was recommended in all cases, it was only prescribed in 50% of the patients. Based on the serum potassium levels and DKA potassium replacement policy, the mean±SD of replacement patients should have received was 84±45 mmol however potassium was under-prescribed in 60% of patients. Potassium was <3.5 mmol in 40% of patients. This study illustrates that divergence from the DKA protocol was common. Trends towards insufficient insulin and potassium replacement were observed with IVF frequently exceeding recommendations. Assessment of individual patient data is needed to determine if the observed divergence was premeditated.