Review of Patients with Diabetic Ketoacidosis Admitted to General Physician Care in a Tertiary Hospital — ASN Events
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Review of Patients with Diabetic Ketoacidosis Admitted to General Physician Care in a Tertiary Hospital (#269)

Richard Gauci 1 , Emma Hamilton 1 , Jonathan Beilin 2 , Gerry Fegan 1
  1. Department of Endocrinology, Fremantle Hospital, Fremantle, WA, Australia
  2. Endocrinology and Diabetes, Royal Perth Hospital, Perth, WA, Australia

Abstract:

Background: Diabetic Ketoacidosis (DKA) incidence in Australia is 4.6-13.4 per 1000 diabetic cases/year.1   Approximately one quarter of new diabetes presentations under 20 years old have DKA.2

Aims: To evaluate outcomes of patients admitted with DKA under general physician care at a tertiary hospital.

Methods: Observational, retrospective study of patients admitted with primary diagnosis of DKA between January 1st and December 31st 2010 to Fremantle Hospital, a 450 bed tertiary hospital in Western Australia.  DKA diagnosis established via coding and confirmed by review of medical record. DKA was managed by standard variable rate insulin infusion protocol. Audit approved by Clinical Governance Unit.

Results: 48 admissions identified from 38 patients over 12 month period. 1 patient presented 6 times and 9 patients required ICU admission. Mean age 39.4 years, mean length of stay (LOS) 2.95 days (± 1.6 days), admission pH 7.1 (± 0.17), bicarbonate 9.2mmol/L (± 5mmol/l), trough potassium 3.4mmol/L (±0.52mmol/l) and recent HbA1c 10.1% (± 2.3). Main precipitating factors were infection (32.2%) and insulin omission (28.8%). Hypokalaemia (<3.5mmol/l) occurred in 56% patients. 10% of patients were newly diagnosed; there were no deaths from DKA during the audit. 63% had attended a diabetic outpatient clinic in preceding year and 81% had outpatient follow up arranged. 21.0% of patients were readmitted for DKA within 1 year. Total number general medicine admissions to FH/year approximates 5000, mean LOS 5.1days.

Conclusions:  DKA accounted for approximately 1% of general medicine admissions and had relatively short LOS. Readmission rate of 21% compares favourably with other data (31%3 ). Infection and insulin omission accounted for majority of presentations and several patients had repeat admissions, suggesting sick day education may need improvement. The high rate of hypokalaemia suggests the protocol for potassium replacement may be inadequate and requires review. Whether speciality endocrinology care provides different outcomes needs evaluation.

  1. Dunning, T. 2005 Diabetic ketoacidosis - prevention, management and the benefits of ketone tesing. Director Endocrinology and Diabetes Nursing Research. St Vincent’s Health & the University of Melbourne.
  2. Rewers A, Klingensmith G, Davis C, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Paediatrics 2008;121;e1258–66.
  3. Allan J. Howarth S. A study into the prevalence of diabetes, the costs and the admission rates of Diabetic ketoacidosis in England’s Primary Care Trusts November 2010.