CLINICAL PROFILE, OUTCOMES AND ADHERENCE TO A STANDARDISED MANAGEMENT BUNDLE IN DIABETIC KETOACIDOSIS PRESENTING TO THE EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL

Abstract

Objective: To determine the clinical profile and outcomes of diabetic ketoacidosis (DKA) in the emergency department and to evaluate adherence to a standardised management bundle and its association with outcomes. Study Design: Prospective observational study. Setting: Department of Accident & Emergency, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: November 2025 to Feburary 2026. Material & Methods: A total of 186 patients aged ≥14 years with DKA (ADA criteria) were enrolled. Completion of four bundle elements within six hours (≥1 L saline in the first hour, fixed-rate intravenous insulin, protocol potassium replacement, hourly glucose monitoring) was recorded; ≥75% completion was high adherence. Resolution time, intensive care unit (ICU) admission, hospital stay and mortality were compared using SPSS 26. Results: Mean age was 49.1 ± 15.6 years, 98 (52.7%) were female and 127 (68.3%) had type 2 diabetes. Infection (71.5%) and missed treatment (55.4%) were the leading precipitants; 21.0% had severe DKA. All four elements were completed in 56 (30.1%) patients and high adherence was achieved in 119 (64.0%). High adherence shortened time to resolution (22.8 ± 7.8 vs 26.9 ± 8.4 hours, p = 0.002), and this persisted after adjustment for severity and age (−4.8 hours; 95% CI −6.9 to −2.8). ICU admission (31.2%) and mortality (10.8%) did not differ by adherence; severity predicted ICU admission (p < 0.001). Conclusion: DKA at our centre predominantly affected adults with type 2 diabetes and was driven by infection and missed treatment. Only one-third of patients received the complete bundle, yet higher adherence was independently associated with faster DKA resolution.