Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 38
Diabetic Ketoacidosis: Do We Need New Management Guidelines?

Mohamed M Hassanein MRCP, UK

Background:
Diabetic ketoacidosis (DKA) is a common medical emergency. Most patients with DKA recover fully following standard treatment with intravenous fluids, electrolytes and insulin. However, there is still a reported 5-10% mortality rate in Western countries. Every effort should be made to prevent this and consequently, many hospitals have DKA management guidelines. A simple detailed management guideline, that is regularly updated, is an important step to improve the outcome of DKA.

Audit: 
To address the quality of management of severe DKA, and to assess the need to modify the guidelines we arranged for an audit of all adults’ DKA admissions in our hospital in the year 2000. We diagnosed 32 patients with DKA (arterial Ph <7.3, ketosis & hyperglycemia). The average age was 39 years and the mean duration of diabetes was 13.3 years. Previous admission with DKA was noted in 72%. The average hospital stay was 5 days in 68% of them. A fatal outcome was reported in 2 patients (6.25%). Infections were the cause of DKA in 53% followed by poor compliance in 28%. Moderately severe acidosis was found in 50%. About 70% needed 5-6 liters of IV fluids within the 1st 24 hours. All patients were initially treated with IV insulin and the majority was later converted to 4 daily SC insulin injections.

Discussion:
There was a significant variation in the management of DKA among these patients. This indicated a low rate of adherence to the hospital management guidelines. This audit indicated that to potentially minimize any unnecessary variation in DKA management, guidelines should provide simple, precise information to the on-call doctors. This should include information on the type of IV fluid and the rate of administration, the amount of K+ needed if any, the amount and rate of insulin, the frequency of and types of investigations needed, as well as many other important factors. Meanwhile, the accessibility of the guidelines in a precise and concise fashion (A4 sheet) is important and hence we propose new guidelines to fulfill these points (details at the meeting). We plan to re-audit the new guidelines for the year 2003.

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