title: Mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care unit and hospital lengths of stay: results of a nonrandomized trial.
abstract: OBJECTIVE
  To determine the effect of a mandatory protocol for treating diabetic ketoacidosis.
  
  
  METHODS
  Chart review of patients treated before and after protocol implementation.
  
  
  METHODS
  University-affiliated U.S. public teaching hospital.
  
  
  METHODS
  A total of 241 consecutive nonpregnant patients >18 yrs old admitted to a medical intensive care unit for diabetic ketoacidosis between January 2000 and January 2005.
  
  
  METHODS
  Implementation of a mandatory treatment protocol in May 2003.
  
  
  METHODS
  Intensive care unit and hospital lengths of stay, time to correction of anion gap and ketone clearance, and hypoglycemic episodes.
  
  
  RESULTS
  Before protocol implementation, the mean +/- sd intensive care unit and hospital lengths of stay were 44 +/- 28 hrs and 91 +/- 73 hrs, respectively. After implementation, intensive care unit and hospital lengths of stay decreased 23% and 30%, to 34 +/- 18 hrs and 64 +/- 41 hrs, respectively (both p < .007). Time to anion gap closure and ketone clearance also decreased (both p < .05). No difference in the number of hypoglycemic episodes was observed.
  
  
  CONCLUSIONS
  Implementing a mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care and hospital lengths of stay and time to anion gap closure and ketone clearance, without increasing the rate of hypoglycemia.
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: Sarah V
authors.initials: SV
authors.lastname: Bull
authors.forename: Ivor S
authors.initials: IS
authors.lastname: Douglas
authors.forename: Mark
authors.initials: M
authors.lastname: Foster
authors.forename: Richard K
authors.initials: RK
authors.lastname: Albert
mesh_terms: D000136:Acid-Base Equilibrium; D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D003120:Colorado; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007659:Ketones / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D037141:Mandatory Programs / Q000592:standards*; D008485:Medical Audit; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D007659:Ketones