23 years of managing diabetic ketoacidosis at Auckland Hospital

Abstract

To examine the length of stay and need for intensive care of people admitted with diabetic ketoacidosis (DKA) to a single centre between 1988 and 2011.Patients aged ≥15 years admitted for the first time with DKA (plasma glucose ≥ 10mmol/L and a bicarbonate concentration ≤15mmol/L and a pH <7.35, and raised plasma or urine ketones or anion gap) to Auckland City Hospital from 1988-2011 were identified retrospectively. The patients were divided into four cohorts (1988-1996; 1997-2001; 2002-2006; 2007-2011). Over this time period there was no significant change to the insulin infusion protocol.There were 576 admissions with DKA in 388 people over the 23 years. The mean age of the patients and glucose concentration at presentation to hospital fell significantly over time. The admission pH and bicarbonate concentration was higher in more recent cohorts. The length of stay and need for intensive care admission fell significantly over time, but the number of patients subsequently readmitted with DKA remained high. In-hospital mortality remained low.DKA remains an important reason for admission to this hospital, but the severity of DKA at presentation has reduced over time. The need for intensive care admission and length of stay has fallen dramatically.