Background: Queensland Health introduced guidelines in 2010 for managing DKA1.
Aim: To compare the current practices in management and measure clinical outcomes of DKA, at two hospitals in Queensland (Gold Coast and Robina), when compared to the QHDP.
Methods: A six‐month (December 2011 to June 2012) retrospective study, included patients that fit the eligibility criteria of DKA. Two treatment groups depending on whether the protocol was followed or not, were compared on all steps of management from the time of presentation to the Emergency Department (ED) until discharge as outlined by the QHDP.
Results: The study cohort included 28 patients (male = 14, female =14) with a mean age of 32 years. Twenty‐four patients (86%) had pre‐existing diabetes. A precipitating cause for DKA was identified in 25 (89%) patients. Infection, alcohol and non‐compliance were the major precipitants. The DKA guidelines were initiated in ED in 46% of patients and on the wards in a further 11%. Forty‐two per cent of patients in both treatment groups had intravenous fluid and insulin commencement within an hour of presentation. Intravenous insulin sliding scale was used in 68% of all cases. There was no difference between the groups with regards to adverse events with hypoglycaemia and hypokalaemia. Capillary ketones were not measured at either site regardless of protocol use. Resolution of DKA was thus determined by clearance of ketonuria in six (21%) patients and resolution of acidosis in 16 (57%). The group that was on protocol had a shorter duration of acidosis (15.75 ± 12.7 vs. 21 ± 14.9 hours, P 0.415) and shorter average length of stay (2.175 ± 1.28 vs. 3.28 ± 2.5 days, P 0.33).
Conclusions: The implementation of QHDP showed trends towards improved clinical outcomes such as duration of acidosis and average length of stay without increasing adverse events. Capillary ketone monitoring should be incorporated into the guidelines in keeping with the evidence-based changes in the management of DKA2,3.