Poster 12: A series of patients with hospital-acquired diabetic ketoacidosis (HADKA): A descriptive analysis

Background: Hospital-acquired diabetic ketoacidosis (HADKA) often complicates hospital admission in people with type 1 (T1D) or type 2 (T2D) diabetes. We aimed to determine the characteristics of these patients and the reasons for HADKA.

Methods: A retrospective analysis of written and electronic notes of patients identified with HADKA at Morriston Hospital by diabetes specialist nurses between January 2016 and January 2022 was undertaken. Patients included were admitted to hospital for a reason other than DKA, aged >18 years and developed DKA in hospital.

Results: Twenty-five patients were included with a mean age 65.2 years; 9 (32.0%) were male, 13 (52.0%) had T1D and 12 (48.0%) had T2D. Patients had a mean pre-admission HbA1c 84.7 mmol/mol (9.9%), and 17 (68.0%) were insulin-treated. Most were initially admitted under medicine (n=14, 56.0%) and the remainder under surgery (n=11, 44.0%). Commoner reasons for HADKA were infection (n=7, 28.0%), insulin omission (n=6, 24.0%) and surgery (n=5, 20.0%).

The mean pH was 7.20, bicarbonate 13.8mmol/L and capillary ketone 5.4mmol/L. Five (20.0%) patients required admission to intensive care following HAKDA diagnosis, and the mean length of hospital stay was 42.6 [range 2-173] days. Three (13.0%) patients died during the hospital admission.

Conclusion: HADKA was identified in a significant number of patients at our hospital and was associated with significant mortality. Earlier recognition of ketonaemia, associated medication use may prevent HADKA and improve outcomes.