The management of diabetic ketoacidosis in adults—An updated guideline from the Joint British Diabetes Society for Inpatient Care

TLDR

The Joint British Diabetes Society provides updated inpatient guidelines for managing adult diabetic ketoacidosis. The guideline specifies that patients aged 16–18 under paediatric care should follow the paediatric protocol, while adults use this guideline, and it adds sections on SGLT2 inhibitor–associated euglycaemic ketoacidosis and management in end‑stage renal failure or dialysis. Based on new evidence of frequent hypoglycaemia and hypokalaemia, the guideline recommends reducing the insulin infusion rate from 0.1 to 0.05 units/kg/h when glucose falls below 14 mmol/L and updates its treatment algorithms.

Abstract

This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of ketoacidosis; available at https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults. The document explicitly states that when a person aged 16-18 is under the care of the paediatric team, then the paediatric guideline should be used, and if they are cared for by an adult team, then this guideline should be used. The guideline takes into account new evidence on the use of the previous version of this document, particularly the high prevalence of hypoglycaemia and hypokalaemia, and recommends that when the glucose concentration drops below 14 mmol/L, that de-escalating the insulin infusion rate from 0.1 to 0.05 units/kg/h should be considered. Furthermore, a section has been added to address the recognition that use of sodium glucose co-transporter 2 inhibitors is associated with an increased risk of euglycaemic ketoacidosis. The management of ketoacidosis in people with end-stage renal failure or on dialysis is also mentioned. Finally, the algorithms to illustrate the guideline have been updated.