title: Evaluation of the treatment of diabetic ketoacidosis in the medical intensive care unit.
abstract: OBJECTIVE
  To determine if treatment of DKA in a sample of adult medical intensive care unit (MICU) patients was consistent with the 2006 ADA Hyperglycemic Crises in Adult Patients with Diabetes Clinical Guidelines.
  
  
  METHODS
  Medical records were reviewed for all adult patients admitted to a MICU with a diagnosis of DKA between July 1, 2007 and June 30, 2010. The primary composite endpoint assessed fluid resuscitation (total mL/kg) at 24 hours, insulin bolus dose, and continuous insulin infusion (units/kg or units/kg/hour) to determine whether the 2006 ADA clinical guidelines for Hyperglycemic Crises in Adult Patients with Diabetes were followed. Secondary outcome measures were DKA resolution, ICU length of stay, frequency of rebound DKA within 48 hours, frequency of hypoglycemia, and time to transition to subcutaneous insulin.
  
  
  RESULTS
  A total of 60 patients met inclusion criteria. For patients treated in compliance with the clinical guidelines compared to those that were not, total volume IV fluid infused during the first 24 hours (4.88 ± 0.77 mL/kg/hour and 2.74 ± 1.08 mL/kg/hour), mean dose of the insulin bolus (0.13 ± 0.04 units/kg and 0.06 ± 0.06 units/kg) and initial rate of the insulin infusions (0.11 ± 0.02 units/kg/hour and 0.08 ± 0.03 units/kg/hour) were significantly different (p <0.001). Treatment of 12 patients (20%) followed the 2006 ADA clinical guidelines, and mean time to resolution of DKA and MICU length of stay trended toward a shorter duration in these patients.
  
  
  CONCLUSIONS
  Compliance with the 2006 ADA Hyperglycemic Crises in Adult Patients with Diabetes clinical guidelines was low for treatment of DKA in a sample of adult patients admitted to a MICU. Institutional guidelines for the management of diabetic ketoacidosis should be investigated as a strategy to improve compliance with national guidelines.
authors.affiliation: PGY-1 Pharmacy Practice Resident, Department of Pharmacy, University of Maryland Medical Center nfusco@rx.umaryland.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fusco
authors.affiliation: Assistant Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gonzales
authors.affiliation: Critical Care Specialist, Department of Pharmacy, University of Maryland Medical Center.
authors.forename: Siu Yan Amy
authors.initials: SY
authors.lastname: Yeung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin