A retrospective review of the intensive care management of diabetic ketoacidosis

Introduction

Diabetic ketoacidosis (DKA) remains a common complication for patients with diabetes mellitus. Despite a relatively low mortality of 2-5 % [1] there remains a substantial morbidity.

Design, methods and patients

All patients who had been admitted to intensive care at St George's Hospital, over a 3 year period, with a primary admitting diagnosis of diabetic ketoacidosis, were retrospectively reviewed from the notes and ICU charts. All patients were treated with similar recognised management plans tor DKA [1].

Results

Expressed as mean (± SEM). Twenty-nine patients were identified with a mean age of 42.3 (± 2.9) years, an APACHE III score of 58.4 (± 3.9) and a predicted mortality of 2.5 (± 0.6)%. The length of stay on the ICU was 3.16 (± 0.6) days.

Conclusions

Despite recognised management plans for DKA there is still a substantial morbidity for these patients. Although the arterial pH return to normal within 24 to 36 h there is still a significant metabolic acidosis, despite an absence of ketones in the urine, normal serum lactate levels and normal blood sugar levels. It is unclear whether this metabolic acidosis has any clinical relevance as the mortality is so low, or if it is reflecting inadequate treatment regimes.

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