Treatment of diabetic ketoacidosis in adults in Denmark: a national survey.
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.
Henriksen
Otto M
OM
Endocrine Section, Department of Internal Medicine I, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen NV, Denmark. omh@dadlnet.dk
Prahl
Julie B
JB
Røder
Michael E
ME
Svendsen
Ole Lander
OL
D000328:Adult; D001639:Bicarbonates / Q000627:therapeutic use; D003718:Denmark; D016883:Diabetic Ketoacidosis / Q000628:therapy*; D005440:Fluid Therapy / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units; D007388:Internal Medicine / Q000379:methods* / Q000592:standards; D007552:Isotonic Solutions / Q000627:therapeutic use; D010346:Patient Care Management / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012965:Sodium Chloride / Q000627:therapeutic use; D011795:Surveys and Questionnaires
D001639:Bicarbonates; D007328:Insulin; D007552:Isotonic Solutions; D012965:Sodium Chloride