Treatment of diabetic ketoacidosis in adults in Denmark: A national survey

Henriksen, Otto M.; Prahl, Julie B.; Røder, Michael E.; Svendsen, Ole Lander

doi:10.1016/j.diabres.2006.10.013

« Previous Next »Diabetes Research and Clinical Practice
Volume 77, Issue 1 , Pages 113-119, July 2007

Treatment of diabetic ketoacidosis in adults in Denmark: A national survey

Otto M. Henriksen
- Endocrine Section, Department of Internal Medicine I, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
- Corresponding author at: Department of Clinical Physiology and Nuclear Medicine, University Hospital Glostrup, Ndr. Ringvej, DK-2600 Glostrup, Denmark. Tel.: +45 4323 2433; fax: +45 4323 3928.
Julie B. Prahl
- Paediatric Department, University Hospital Gentofte, Niels Andersen Vej 65, 2900 Hellerup, Denmark
Michael E. Røder
- Endocrine Section, Department of Internal Medicine I, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
Ole Lander Svendsen
- Endocrine Section, Department of Internal Medicine I, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark

Received 31 March 2006; accepted 13 October 2006. published online 26 November 2006.

Abstract

The aims of this study were to investigate management routines of diabetic ketoacidosis (DKA) in adult patients in departments of internal medicine in Denmark and to relate current routines of treatment to available evidence.

A questionnaire requesting information on management routines of DKA was sent to all departments of internal medicine in Denmark responsible of managing DKA. Fifty-nine departments (88%) returned the questionnaire and/or a copy of their management protocol.

At 19 departments (32%), all patients with DKA were managed in an intensive care unit (ICU). Twenty-four different insulin regimens and 21 fluid protocols were identified. Routines of insulin therapy varied in terms of doses and routes of administration. Fifty-eight departments (97%) used isotonic saline for hydration. Potassium supplements were administered as a separate infusion of either isotonic potassium-sodium-chloride (83%) or isotonic potassium-chloride (10%). Recommended volumes to be administered during the first 8h of treatment varied significantly (median 4800ml, range 3750–7700ml). Use of bicarbonate was endorsed by 80%.

This study shows significant variations in management routines of DKA in Denmark. In many cases, the treatment routines employed are not supported by evidence from clinical trials. We recommend implementation of national and/or European guidelines for management of DKA in adult patients.

Keywords: Diabetes, Ketoacidosis, Treatment, Guidelines