Successful management of diabetic ketoacidosis: an innovative protocol

Abstract

As the prevalence of diabetes increases worldwide, so the numbers of hospital admissions with patients suffering complications, such as diabetic ketoacidosis (DKA), have risen. Morbidity and mortality are affected by delays in presentation and diagnosis, and complications of management. In March 2010, the Joint British Diabetes Societies (JBDS) published national UK guidance on the management of DKA, which was updated in 2013. Both national and local surveys performed since have demonstrated high rates of hypoglycaemia and hypokalaemia, potentially life-threatening complications. The West Suffolk Hospital critical care unit guideline incorporates additional safety features to avoid both hypoglycaemia and hypokalaemia, compared with the JBDS guidelines. Retrospective case note review was performed in May 2015 and May 2017 of patients admitted to the critical care unit in the preceding 18 and 15 months meeting the JBDS diagnostic criteria. Our results showed only 15% and 9% of our patients experienced hypoglycaemia, in contrast with 28% in the national DKA survey. While our incidence of hypokalaemia was similar to the national survey, adjustments to our guideline in December 2015 resulted in a marked decrease in the percentage of time spent hypokalaemic by patients on fixed rate intravenous insulin. We believe there is capacity for improvement of DKA guidelines to reduce the incidence of complications of management, and encourage adjustment of guidelines following our findings. Copyright © 2018 John Wiley & Sons.