Background:Diabetic Ketoacidosis (DKA) is a hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. It is a medical emergency with a significant morbidity and mortality. It is however a potentially reversible condition in case an emergency and immediate medical attention, prompt recognition, diagnosis and treatment were provided.
Aim of the Study:was to leverage the current research data in order to construct a treatment guideline for diabetic ketoacidosis in the emergency department.
Methods:A literature search was carried out on MEDLINE (including MEDLINE in-process), CINAHL,Embase and the Cochrane Library. Databases using “diabetic ketoacidosis" as a MeSH heading and as textword. High yield journals were also hand searched.
Findings:The initial treatment phase aims to restore circulating volume, reduce blood glucose levels, to correct any electrolyte imbalances and to reduce ketone levels which in turn corrects the acidosis. Evidence also showed that there is no need for insulin bolus prior to starting an insulin drip in the treatment of diabetic ketoacidosis. Also, using beta-hydroxybutyrate at presentation can expedite diagnosis and therefore treatment. Implementing treatment guidelines into the emergency department may help expedite diagnosis and treatment.
Conclusion:Prompt first line management of DKA is the most critical stage to profoundly reduce morbidity and mortality rates of this potentially fatal crisis. It's therefore crucial to follow the evidence-based guidelines and DKA protocol in the emergency department to expedite diagnosis, guide treatment, and improve continuity of care between the emergency department and the ICU as well as improving the clinical outcomes of patients with DKA. Initially, this will improve outcomes by decreasing the delay until treatment is initiated andprovide a continuum of treatment between the emergency department and the intensive care unit.
Furthermore, the healthcare providersmust ensure that they have the ability to provide support and education to people at risk of developing DKA and those that have had an episode of DKA by spreading awareness and education to help reduce both the initial occurrence and recurrence of this often preventable life-threatening condition.