Are the results from the 2014 UK national survey on the management of diabetic ketoacidosis applicable to individual centres?

BACKGROUND: In 2013 the Joint British Diabetes Societies published an update to their 2010 guideline on the management of diabetic ketoacidosis (DKA). In 2014 a national survey was conducted to assess the management of DKA across the UK using the JBDS or local guidelines. Hospitals were invited to submit data on 5 people presenting with DKA. These data were published in 2016. However, whether those national results were applicable to individual hospitals remains unknown. AIM: To assess the management of people presenting with DKA at a single hospital and compare the results with the national dataset. METHODS: Using the identical data collection tool as used in the national survey we collected information on 40 subjects (a total of 52 admissions) admitted with DKA between April 2014 and July 2015. RESULTS: The data collected locally were very similar to those found in the national dataset. The management of DKA was best during the first few hours after admission, then biochemical and physical monitoring frequency decreased. The number of people who developed hypokalaemia and hypoglycaemia were very similar to the national data. Rates of biochemical improvement were slightly better locally. CONCLUSIONS: The data from the national DKA survey, even though based on a maximum of 5 people per hospital from across the UK are applicable at a hospital level.

The risk factors and outcome of fungal peritonitis in continuous ambulatory peritoneal dialysis patients.

AIM: To determine the risk factors and outcome of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients over a 7-year period. PATIENTS AND METHODS: This retrospective study was conducted on 30 cases of fungal peritonitis in CAPD patients during a 7-year period (2000-2007). The diagnosis was based on elevated CAPD effluent count and isolation of fungi. Patients were evaluated for previous episode of bacterial peritonitis. RESULTS: The incidence of fungal peritonitis was 16.2%. Age varied between 8 and 75 years, with a mean age of 57 years. Twenty-three were males (76.7%) and seven were females (23.3%). Seventeen patients (56.6%) had previous episodes of bacterial peritonitis that was treated with multiple antibiotics. The common fungus was Candida species (50%). CAPD catheter removal and initiation of antifungal therapy was done for all patients. Reinsertion was done for three (10%) patients. Mortality rate was 20%. CONCLUSION: Patients with previous bacterial peritonitis and antibiotic usage are at greater risk of developing fungal peritonitis.