title: 23 years of managing diabetic ketoacidosis at Auckland Hospital
abstract: To examine the length of stay and need for intensive care of people admitted with diabetic ketoacidosis (DKA) to a single centre between 1988 and 2011.
  
  
  
  Patients aged ≥15 years admitted for the first time with DKA (plasma glucose ≥ 10mmol/L and a bicarbonate concentration ≤15mmol/L and a pH <7.35, and raised plasma or urine ketones or anion gap) to Auckland City Hospital from 1988-2011 were identified retrospectively. The patients were divided into four cohorts (1988-1996; 1997-2001; 2002-2006; 2007-2011). Over this time period there was no significant change to the insulin infusion protocol.
  
  
  
  There were 576 admissions with DKA in 388 people over the 23 years. The mean age of the patients and glucose concentration at presentation to hospital fell significantly over time. The admission pH and bicarbonate concentration was higher in more recent cohorts. The length of stay and need for intensive care admission fell significantly over time, but the number of patients subsequently readmitted with DKA remained high. In-hospital mortality remained low.
  
  
  
  DKA remains an important reason for admission to this hospital, but the severity of DKA at presentation has reduced over time. The need for intensive care admission and length of stay has fallen dramatically.
authors.affiliation: Department of Medicine, University of Auckland, Park Road, Auckland.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Braatvedt
authors.affiliation: Higher Education Development Centre, University of Otago, Dunedin.
authors.forename: Amelia
authors.initials: A
authors.lastname: Tekiteki
authors.affiliation: General Medicine, Auckland City Hospital, Auckland.
authors.forename: Holly
authors.initials: H
authors.lastname: Britton
authors.affiliation: General Medicine, Auckland City Hospital, Auckland.
authors.forename: John
authors.initials: J
authors.lastname: Wallace
authors.affiliation: Diabetes Centre, Green Lane Hospital, Auckland.
authors.forename: Manish
authors.initials: M
authors.lastname: Khanolkar
mesh_terms: D000328:Adult; D017677:Age Distribution; D001786:Blood Glucose / Q000378:metabolism; D003422:Critical Care / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D016883:Diabetic Ketoacidosis / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data; D007902:Length of Stay / Q000639:trends; D008297:Male; D009520:New Zealand / Q000453:epidemiology / Q000208:ethnology; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin