Table 1.
Minimal and ideal set for diagnosis and management of diabetic ketoacidosis (DKA) in higher-level health care facilities.
| Domain | Item | Measured in SPA survey |
|---|---|---|
| Minimal set | ||
| Medications | Insulin, disaggregated by type and method of injection | Partial: Disaggregation by type not available in most surveysa and by method in all surveys |
| IV fluids: normal saline or ringer's lactate | Yes | |
| IV fluids: glucose containing fluids (dextrose - regardless of %) | Yes | |
| Potassium | No | |
| Oral rehydration salts (ORS) | Yes | |
| Equipment | Glucometer: machine | Yes |
| Age appropriate IV supplies: adult and pediatric | Yes | |
| Age appropriate blood pressure apparatus, digital and/or manual | Yes | |
| Insulin syringe | No | |
| Diagnostic (consumables) | Ketones test (urine dipstick) | Yesb |
| Glucometer: test strips | Yes | |
| Staff and guidelines | Guidelines for diabetes diagnosis and treatment, including guidance on management of DKA | Partial: surveys do not report on guidance regarding DKA management specifically |
| Presence of a health care worker trained in diabetes diagnosis and treatment | Yes | |
| 24-h staff | Yes | |
| Ideal setc | ||
| Medications | Glucagon | No |
| Mannitol | No | |
| Equipment | Age-appropriate weight scale: adult and pediatric | Yes |
| Thermometer | Yes | |
| IV pump | No | |
| Blood chemistry analyzer, in the facility | Yes | |
| Diagnostics (consumables) | Blood chemistry analyzer reagents (creatinine, potassium, sodium, bicarbonate, chloride, glucose) | No |
a
Only the Malawi 2013-14 survey allowed for disaggregation of insulin type by survey. All other surveys collected information on the availability of insulin “lente” or the type was not specified.
b
The SPA question refers to “urine protein test” but does not specify urine ketone testing. Most urine protein dipstick tests also allow for testing of ketones.
c
The ideal set includes all items in the minimal set in addition to the items listed under this category.