Addressing Pitfalls in Management of Diabetic Ketoacidosis with a Standardized Protocol
| Autor: | Jodie Reider, Runa Acharya, Rose A. Salata, Ronald A. Codario, Neha D. Karajgikar, Mary T. Korytkowski, Amy C. Donihi, Pooja Manroa |
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| Rok vydání: | 2019 |
| Předmět: |
Blood Glucose
endocrine system diseases Diabetic ketoacidosis Endocrinology Diabetes and Metabolism medicine.medical_treatment Anion gap 030209 endocrinology & metabolism Hypoglycemia Diabetic Ketoacidosis law.invention 03 medical and health sciences 0302 clinical medicine Endocrinology Interquartile range law medicine Humans Insulin 030212 general & internal medicine Retrospective Studies American diabetes association business.industry nutritional and metabolic diseases General Medicine medicine.disease Intensive care unit Discontinuation Intensive Care Units Anesthesia business |
| Zdroj: | Endocrine Practice. 25:407-412 |
| ISSN: | 1530-891X |
| DOI: | 10.4158/ep-2018-0398 |
| Popis: | Objective: To determine the efficacy and safety of a diabetic ketoacidosis (DKA)-Power Plan (PP) for guiding intravenous (IV) insulin infusions prior to anion gap (AG) closure and administering subcutaneous (SC) insulin ≥1 hour before discontinuing IV insulin. Methods: Retrospective chart review of patients with DKA before (pre-PP) (n = 60) and following (post-PP) (n = 60) implementation of a DKA-PP. Groups were compared for percentage of patients for whom IV insulin therapy was continued until AG closure, the percentage of patients receiving SC insulin ≥1 hour before discontinuation of IV insulin, and percentage of patients with rebound DKA during the index hospitalization. Results: Admission plasma glucose (514 mg/dL vs. 500 mg/dL; P = .36) and venous pH (7.2 vs. 7.2; P = .57) were similar in pre- and post-PP groups. Inappropriate discontinuation of IV insulin occurred less frequently in post-PP patients (28% vs. 7%; P = .007), with a lower frequency of rebound DKA (40% vs. 8%; P = .001) following acute management. More post-PP patients received SC insulin ≥1 hour before discontinuation of IV insulin (65% vs. 78%; P = .05). Conclusion: Implementation of a DKA-PP was associated with appropriate discontinuation of IV insulin in more patients, more frequent administration of SC insulin ≥1 hour prior to discontinuation of IV insulin, and fewer episodes of rebound DKA. Abbreviations: ADA = American Diabetes Association; AG = anion gap; BG = blood glucose; DKA = diabetic ketoacidosis; DKA-PP = DKA-Power Plan; ICU = intensive care unit; IQR = interquartile range; IV = intravenous; IVF = IV fluid; LOS = length of stay; SC = subcutaneous |
| Databáze: | OpenAIRE |
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