Geoffrey Braatvedt1, Alfred Kwan2, Will Dransfield3, Catherine McNamara4, Cameron Schauer2, Steven Miller4, Manish Khanolkar3. 1. Associate Professor of Medicine, Department of Medicine, University of Auckland, Auckland. 2. Medical Registrar, Department of Medicine, Auckland City Hospital, Auckland. 3. Physician, Department of Medicine, Auckland City Hospital, Auckland. 4. Physician, Department of Medicine, North Shore Hospital, Shakespeare Road, Auckland.
Abstract
AIMS: To compare the outcome of people with type 1 diabetes admitted to the general ward with diabetic ketoacidosis (DKA) to two hospitals in Auckland, using different protocols of care. METHODS: North Shore Hospital uses a UK weight-based, ketone centric protocol while Auckland Hospital uses a protocol based on glucose measurements only. All notes of people over 16 years of age admitted to the general wards with DKA to these hospitals in one year were reviewed and their outcome compared. RESULTS: Forty-one admissions in 35 people with DKA at Auckland Hospital were compared to 30 admissions in 26 people with DKA at North Shore Hospital. The degree of ketoacidosis and hyperglycaemia on admission was similar at the two hospitals. The duration of insulin and 10% dextrose infusions was similar but the total number of units of insulin infused and rate of dextrose given per hour were higher at North Shore, with similar rates of hypokalaemia and hypoglycaemic events at each site. The rate of resolution of hyperglycaemia and acidosis did not differ. The length of stay of patients was similar at the two hospitals. CONCLUSIONS: The frequent measurement of bedside ketones did not result in more rapid resolution of DKA compared to relying on glucose measurements alone.
AIMS: To compare the outcome of people with type 1 diabetes admitted to the general ward with diabetic ketoacidosis (DKA) to two hospitals in Auckland, using different protocols of care. METHODS: North Shore Hospital uses a UK weight-based, ketone centric protocol while Auckland Hospital uses a protocol based on glucose measurements only. All notes of people over 16 years of age admitted to the general wards with DKA to these hospitals in one year were reviewed and their outcome compared. RESULTS: Forty-one admissions in 35 people with DKA at Auckland Hospital were compared to 30 admissions in 26 people with DKA at North Shore Hospital. The degree of ketoacidosis and hyperglycaemia on admission was similar at the two hospitals. The duration of insulin and 10% dextrose infusions was similar but the total number of units of insulin infused and rate of dextrose given per hour were higher at North Shore, with similar rates of hypokalaemia and hypoglycaemic events at each site. The rate of resolution of hyperglycaemia and acidosis did not differ. The length of stay of patients was similar at the two hospitals. CONCLUSIONS: The frequent measurement of bedside ketones did not result in more rapid resolution of DKA compared to relying on glucose measurements alone.