Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Observational study of Diabetic Ketoacidosis admissions at two tertiary hospital sites in Western Australia from 2008-2010. (#275)

Kyaw Thura 1 , Emma J Hamilton 2 , Wendy Davis 3 , Richard Gauci 4 , Roland Chee 5 , P. Gerry Fegan 2 , Jonathan Beilin 2
  1. Department of Endocrinology and Diabetes, Fremantle Hospital, Perth, WA, Australia
  2. Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, WA, Australia
  3. School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Perth, WA, Australia
  4. Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, WA, Australia
  5. Department of General Medicine, Internal Medicine Unit, Royal Perth Hospital, Perth, WA, Australia


Diabetic ketoacidosis (DKA) contributes to mortality and morbidity in type 1 diabetes.  The incidence of DKA is increasing in Australia (4.6-13.4 per 1000 diabetic cases/year).


  • Describe characteristics of inpatients with DKA in tertiary care.
  • Compare outcomes for inpatients with DKA in Royal Perth Hospital (RPH) under the care of Endocrinologists to patients admitted under General Physicians in Fremantle Hospital (FH); both sites utilised variable dose insulin infusion protocols.


An observational, retrospective audit of 136 DKA admissions in 115 patients (88 admissions to RPH from 2008 to 2009 and 48 admissions to FH in 2010). DKA diagnosis established via clinical coding and confirmed by medical record review.


The mean±SD age of patients presenting with DKA was 35.8±15.5 years, median [IQR] diabetes duration 9.0 [2.5-15.0] years and HbA1c 10.8 [8.7-12.5] %.  49.1% of patients experienced a previous episode of DKA.  Main precipitants of DKA included infection (33.1%), insulin omission (31.5%), alcohol (3.1%) and illicit drug use (1.5%).  At presentation, median pH was 7.14 [6.98- 7.24] and bicarbonate was 8.0 [5.0- 12.9] mmol/L.   Mean trough potassium (K) level was 3.4±0.5 mmol/L and hypokalaemia (K< 3.5mmol/L) occurred in 58% of admissions.  Median length of stay (LoS) was 3 [2-6] days; there was no difference in LoS or trough potassium levels (p≥0.37) between sites. 86.1% of patients had a Diabetes Outpatient appointment scheduled following admission but only 51.4% of patients attended. Prior DKA (OR(95%CI): 5.6(1.4- 22.1)) and lower trough K level (0.2(0.1- 0.8)) were associated with recurrent DKA during the audit in multiple logistic regression analysis.


Infection and insulin omission were the most common precipitants of DKA.  Prior DKA was associated with increased risk of recurrent DKA indicating that sick day education could be optimised.  The low attendance at follow-up clinics highlights the importance of inpatient engagement.