Diabetes Mellitus (DM) is on the increase globally, with further increases expected in developing countries, such as South Africa. World Health Organization (Medical Chronicle, 2006:14) estimations indicate that the number of DM sufferers will double over the next 30 years. This increasing number of diabetics is expected to have enormous economical implications. One of the consequences of the increase in DM sufferers is the increase in deaths due to diabetes related complications. In 2000, 3.2 million people died of DM and diabetes related complications compared with 3 million who died from HIV/AIDS related illnesses (William & Pickup, 2004:64). Health services are financially burdened by DM complications that result in heavy demands in both direct costs of hospitalization and medication as well as indirect costs such as manpower of staff involved in the care of the patient (Leuner, 2000:410). Diabetic ketoacidosis (DKA) is a prominent life-threatening complication of type 1 diabetes mellitus and, if not treated medically, it can lead to coma and death. DKA accounts for 14 per cent of all diabetic related hospital admissions and has a mortality rate of 5 to 10 per cent (Pickup & Williams, 2003:1). Rapid identification of DKA is necessary to improve patient care. George- Gray and Chernecky (2002:96) suggest patient outcomes are affected by the nurse’s ability to recognize the clinical features of DKA. It is important, therefore, for the nurses to understand the signs and symptoms and treatment of this diabetes related complication. National health policies and treatment guidelines should be aimed at addressing DKA treatment through setting guidelines for diabetic care (Peters, 2004:22). The main goal of this study was to determine registered nurses’ knowledge of DKA and to develop guidelines to assist registered nurses in providing adequate and effective health care to prevent DKA reoccurrence. The research study is based pm Bergam’s model on quality of care and accountability. Bergman claims that several preconditions must be filled in order to be accountable, including: • Accountability • Responsibility • Authority • Ability (Bergman (1982:8) emphasizes that ability reflects the registered nurses’ accountability, which is composed of values, knowledge and skills.) The study was divided into two phases. Phase one determined registered nurses’ knowledge related to the management of DKA. Phase two of the study included the developing guidelines to assist registered nurses in providing adequate and effective health care to patients with DKA. The design of the study is quantitative, explorative, descriptive and contextual; a survey was performed using a questionnaire based on a literature study. Ethical principals were maintained throughout the study. Permission to the study was sought from the Local Health Authorities and the heads of department where the research was undertaken. Findings of the research were analysed and discussed in the research. The knowledge of the majority of the respondents was found to be average. Out of the thirty- two respondents 52.8 percent possessed adequate knowledge the management of DKA and 63.4 percent possessed adequate knowledge on the management of DM. Two recommendations to assist registered nurses in the implementation of guidelines of the recommendations were also provided.