Fluid management in diabetic ketoacidosis: are we adhering to recommended guidelines?

Abstract

Introduction: Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that requires prompt treatment. However delays in treatment are common and can have serious consequences. Local guidelines state all patients with DKA should receive intravenous fluids within 60 minutes. This audit series establishes if there is local adherence to this guideline. Methods: In total 111 cases were audited over four consecutive years. Case notes were identified retrospectively by clinical coding and notes were reviewed to establish the time between arrival to Accident and Emergency and administration of intravenous fluids. Results: In 2008, 17 of 29 patients who attended Accident and Emergency with DKA received intravenous fluids as per the guideline, 11 of 24 patients in 2009, 17 of 28 patients in 2010 whilst in 2011 20 of 27 patients received fluids as recommended. Discussion: Although this audit found that there have been improvements in administration of prompt intravenous fluids at Whittington hospital, there are still patients who do not receive this treatment as recommended. It remains to be seen if the introduction of bedside ketone testing will facilitate a speedier diagnosis and therefore more timely initiation of intravenous fluids.