Endocrine Abstracts

Background: Diabetic ketoacidosis (DKA) and Hyperglycaemic Hyperosmolar State (HHS) are serious emergencies with clear management guidelines, requiring early recognition and treatment. There are limited recommendations for uncomplicated hyperglycaemia management in the ED.

Aim: To review current practices regarding management of emergency and non-emergency presentations of hyperglycaemia to St. James’s Hospital ED.

Methods: A retrospective review was carried out. All adults presenting to St James’s Hospital ED from 1/4/23 to 31/9/23 with ‘hyperglycaemia’ or ‘diabetes’ as their coded presenting complaint were included. Their notes were examined for those with DKA or HHS and compliance to guidelines was assessed. The management of non-emergency hyperglycaemia presentations were also studied.

Results: 66 patient encounters were included. 27% had type 1 diabetes mellitus. 63% had type 2 diabetes mellitus and 10% had a new diagnosis. 24% (n = 16) of the presentations were DKA. Just over 80% of DKA patients had appropriate initial and maintenance fluids prescribed in accordance with electrolyte levels. All DKA patients had a fixed rate insulin infusion started. Only 1 of those pre-established on insulin had their long-acting insulin prescribed. 62% had IV Dextrose prescribed pre-emptively resulting in initiation in all those whose blood sugar level (BSL) dropped below 15 mmol/l. No one without a pre-emptive prescription had Dextrose started when BSLs fell. 69% had hourly BSLs checked while only 56% had hourly ketone checks. 3 patients presented in HHS. 2 were managed with fluids, however one was immediately started on an insulin infusion. Of the remaining 47 patient encounters 19 were discharged. Of the 28 admitted only 13 were given treatment in ED.

Conclusions: We highlight the strengths and weaknesses of hyperglycaemia management in our department. Management guidelines of DKA and HHS increase compliance but cannot guarantee it. The management of non-emergency hyperglycaemia is highly variable depending upon patient factors and physician experience.