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Diabetic ketoacidosis (DKA) is a common diabetic emergency often managed by general physicians. However, in contrast to its management in children, there was no national guideline/protocol for adults until the recent national protocol was issued for use throughout Scotland. This national protocol was developed from the audit activity described in this article.A prospective audit of the management of DKA and local protocol adherence was carried out at Raigmore Hospital, Inverness (April 2000 to March 2001). This showed deficiencies in the management of DKA with delay in intravenous fluid and insulin administration, and laboratory monitoring being undertaken less frequently than recommended by local guidelines.In addition, 14 DKA management protocols from 17 Scottish trusts were reviewed. The rate and volume of fluid replacement varied slightly between the trusts. There was general agreement within protocols on laboratory monitoring, potassium replacement, insulin administration and bicarbonate usage.The audit showed that there was scope for improvement in the management of DKA and that there were sufficient similarities in protocols used throughout Scotland to allow collaboration on a national protocol. It is anticipated that this will serve to enhance the profile of guidelines and facilitate standardisation and therefore improvement in patient care. Copyright © 2007 John Wiley & Sons.