Diabetic ketoacidosis in adults at Auckland Hospital, 1988-1996

Background: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Recent evidence suggests that patients with both type 1 and type 2 diabetes can develop DKA. Aim: To review the experience in managing patients admitted to Auckland Hospital with DKA over an eight year period. Methods: A retrospective chart review was undertaken to identify patients with a discharge code of DKA admitted to Auckland Hospital between May 1988 and October Results: One hundred and twenty-five patients were identified who met the defined criteria for DKA. The in-patient mortality for the group was 2.4%. Thirteen patients (10.4%) probably had type 2 diabetes. Thirty-eight (30.4%) patients were admitted to the Department of Critical Care Medicine (DCCM) - these patients had a significantly lower systolic blood pressure and arterial pH, together with a significantly higher admission blood glucose and longer duration of insulin infusion than those not admitted to DCCM. Following their index admission 25% of patients were readmitted to hospital with DKA during the study period. Errors in insulin self-administration that contributed to admission to hospital with DKA were identified in 61% of the patients with known diabetes. Conclusions: Patients with DKA in this study spent about a week in hospital and a significant proportion were admitted to the DCCM. In spite of this the overall mortality was low. Many of these patients were readmitted to hospital with DKA. A small number of patients with DKA may have type 2 diabetes and may not need long term insulin therapy. More effort on patient education regarding insulin use with illness, may prevent admission to hospital with DKA.