• Karen De Beer, Sindhu Michael, Meera Thacker, Elizabeth Wynne, Caroline Pattni, Mandy Gomm, Carol Ball, Dominic Walsh, Andrew Thomlinson, and Kevin Ullah.
• ICU, Royal Free Hampstead NHS Trust, London, UK.
• Nurs Crit Care. 2008 Jan 1;13(1):5-11.

BackgroundThe aim of this study was to establish a standardized approach to the initial care of patients with diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS). DKA and HHS are metabolic emergencies. Effective and efficient management is the responsibility of the multidisciplinary team. The admission of patients to the intensive care unit (ICU) with DKA and HHS is rare, and management of patients' diverse problems is prone to error because of a lack of familiarity.AimThe paper's aim is to set the developmental process of a clinical guideline following a review of the literature.DiscussionThis clinical guideline is based on a review of the evidence available within the literature in the early phase of resuscitation. Collaborative working among the multidisciplinary team through clinical practice group was the method adopted. Management of DKA and HHS is divided into three main areas: intravenous fluid replacement, insulin therapy and electrolyte management. The controversy associated with the administration of sodium bicarbonate is discussed.ConclusionEffective treatment requires a rapid initial assessment of the patient based on current medical history and clinical presentation. To this end, a quick reference algorithm and guide to management were also developed. Key criteria for evaluating the effectiveness of treatment are provided and complications of treatment are addressed. The formation of the practice development group that led to this innovation is outlined, and in conclusion, the success of the group is reflected upon.

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