Managing Fluids in Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is a major, life-threatening complication associated with diabetes mellitus that must be managed as soon as possible. If DKA is not immediately treated it can lead to severe consequences, including death. According to local guidelines, patients experiencing DKA are strongly advised to receive intravenous fluids within an hour of its occurrence. However, this is not always the case. Therefore, researchers Freudenthal et al. wanted to know exactly how often the guidelines for treating DKA are not followed in a clinical setting.

Researchers looked at 111 cases of DKA over a period of four years. According to the authors, "case notes were identified retrospectively by clinical coding and notes were reviewed to establish the time between arrival to Accident and Emergency and administration of intravenous fluids."

Results showed that in 2008, 17 of 29 individuals with DKA received fluids within the first hour as recommended, 11 of 24 individuals in 2009, 17 of 28 in 2010, and 20 of 27 in 2011. It can be seen that over the years there have been slight improvements in fluid management in patients with DKA, yet there are still patients that are not treated as quickly as they should be.

With the introduction of bedside ketone testing now, Freudenthal et al. are interested in studies that will determine whether this testing will improve DKA diagnosis and therefore, decrease the time it takes to manage fluids related to the complication.

Freudenthal R, et al. Fluid Management in Diabetic Ketoacidosis. British Journal of Diabetes and Vascular Disease. 2013;13(3):138-142.