How are we doing with our DKA management? Probably pretty well according to recent article in Critical Care which looks at over 8000 DKA presentations to Australian and New Zealand ICUs from 2000 to 2013.
Overall presentations of DKA are up (fivefold!) but mortality has remained low and steady. Reasons for the impressive increase in presentations include increasing incidence of DKA in the community, increased glucometer use, and increase in the number of certified rural and regional ICUs.
Over 80% of admissions to the ICU are from the emergency department. Over the study period, there was an improvement in worst pH and worst bicarbonate in the first 24 hours of ICU stay over the time period studied – this may reflect better initial resuscitation and institution of DKA protocols in the ED.
Interestingly elevated urea levels were strongly independently associated with mortality.
This article is a good reminder of this common ED presentation with some fresh epidemiological info and perhaps a new marker of mortality (urea) to consider when you next treat a DKA patient in your ED.