A medical audit on management protocol of Diabetic Ketoacidosis in EMW

Abstract

A retrospective medical audit was conducted on patients admitted in East Medical Ward from January 2004 to July 2005 with a diagnosis of diabetic ketoacidosis. There were 44 patients included in this audit. Patients who had initial blood sugar level more than 250mg/dl and later found to have negative urinary ketones were excluded from the audit. Data was collected on a predesigned proforma and was analysed by the programme SPSS version 10. Results: We found that mean age of the patients was 35.39 ± 18.26 years including 21 (47.7%) males and 23 (52.3%) females. Fourteen (31.8%) patients had their first presentation as diabetic ketoacidosis where as rest of the patients were known diabetics including 56.8% diabetic for less than 10 years and 11.4% diabetic for more than 10 years. Blood sugar level of all the patients was checked at presentation and none of them had blood sugar level less than 250mg/dl and record was missing for 3 patients. Urinary ketones of 44 patients were found to be positive with a max.no. 20 (45.5%) having 4+ ketones where as 3 had their record missing. We found that out of 44 patients arterial blood gases record of 36 (81.8%) patients was available ( mean pH = 7.0786,mean pCO2 = 22.231, mean HCO3 = 12.867) and 8 (18.2%) had their record missing. Serum electrolytes investigation record showed that 11 (25%) patients had their record missing for serum Na+ and K+. Rest of the patients had their record available in which serum Na+ ranged from 131 to 151 mEq/L where as serum K+ values showed that only 1(2.3%) patient had hyperkalemia (serum K+ >5.5) and 4(9.1%) had hypokalemia (serum K+ <3.5).