What are the key management strategies for a patient with diabetic ketoacidosis presenting in primary care?

Key management strategies for a patient presenting with diabetic ketoacidosis (DKA) in primary care include:

• Immediate recognition and suspicion of DKA: Suspect DKA in any patient with diabetes presenting with symptoms such as nausea, vomiting, abdominal pain, hyperventilation, dehydration, or reduced consciousness, even if blood glucose is normal, especially in children and young people on insulin therapy NICE NG18.
• Urgent hospital referral: Patients suspected of having DKA must be sent immediately to a hospital with appropriate acute facilities for urgent assessment and treatment; DKA cannot be managed safely in primary care NICE NG18.
• Ketone measurement if available: If near-patient blood ketone testing (beta-hydroxybutyrate) is available, measure ketones to support diagnosis; if elevated or if testing is unavailable, urgent hospital referral is mandatory NICE NG18.
• Explain seriousness and need for urgent care: Inform the patient and their family or carers that DKA is a serious condition requiring urgent hospital assessment NICE NG18.
• Do not initiate treatment beyond basic supportive measures: In primary care, do not attempt intravenous fluids or insulin therapy; these require hospital-based monitoring and specialist care NICE NG18.

In summary, the key management strategy in primary care is prompt recognition of DKA and immediate urgent referral to hospital for definitive management, supported by ketone testing if available and clear communication about the seriousness of the condition NICE NG18,NICE NG17.