Public Health and Primary CareBRIEF REPORT

Diabetic ketoacidosis diagnosis in a hospital setting

Amber M. Healy, DO; Mallory Faherty, PhD, ATC; Zeryab Khan, DO; Naveen Emara, DO; Cody Carter, DO; Andrew Scheidemantel, DO; Musa Abu-Jubara, DO; and Robert Young, DO
Notes and Affiliations
Notes and Affiliations

Received: January 26, 2023

Accepted: May 8, 2023

Published: July 7, 2023

  • Amber M. Healy, DO, 

    Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA

  • Mallory Faherty, PhD, ATC, 

    Ohio Health Research Institute, Columbus, OH, USA

  • Zeryab Khan, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

  • Naveen Emara, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

  • Cody Carter, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

  • Andrew Scheidemantel, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

  • Musa Abu-Jubara, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

  • Robert Young, DO, 

    Ohio Health Doctors Hospital, Columbus, OH, USA

J Osteopath Med; 123(10): 499-503

Context: Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.

Objectives: The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to identify the frequency of endocrinology or diabetology consultation in the hospital setting.

Methods: A retrospective chart review was conducted utilizing charts from three different hospitals within a hospital system. Charts were identified utilizing ICD-10 codes for admissions to the hospital for DKA. If the patient was over 18 and had one of the diagnostic codes of interest, the chart was reviewed for further details regarding the criteria for DKA diagnosis as well as admission and treatment details.

Results: A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4 % of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. Most patients were admitted to the intensive care unit (ICU) and treated with IV insulin infusion (n=288). Consultation of endocrinology or diabetology occurred in 40.2 % (n=209) of all hospital admissions, and 128 of those consults occurred in ICU admissions. The diagnosis of DKA was incorrect in 92 of the patients admitted to the medical surgical unit (MSU) and in 49 of patients admitted to the ICU.

Conclusions: Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.

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