title: A Pediatric Diabetic Ketoacidosis Management Protocol Incorporating a Two-Bag Intravenous Fluid System Decreases Duration of Intravenous Insulin Therapy.
abstract: OBJECTIVES:Diabetic ketoacidosis (DKA) is a leading cause of morbidity and mortality in children with type 1 diabetes. We implemented a standardized DKA management protocol by using a 2-bag intravenous (IV) fluid system. The purpose of the study was to examine if the protocol improved clinical outcomes and process efficiency.METHODS:This was a retrospective study of patients who did and did not undergo the protocol. Patients were included if they were 18 years of age or younger, were diagnosed with DKA, admitted to an intensive care unit or stepdown unit, and received continuous IV insulin.RESULTS:Of 119 encounters evaluated, 46 (38.7%) received treatment with the protocol and 73 (61.3%) did not. The median time to normalization of ketoacidosis was 9 hours (IQR 5-12) and 9 hours (IQR 6.5-13) for protocol and non-protocol groups, respectively (p = 0.14). The median duration of IV insulin therapy was 16.9 hours (IQR 13.7-21.5) vs. 21 hours (IQR 15.3-26) for protocol and non-protocol groups (p = 0.03). The median number of adjustments to insulin drip rate was 0 (IQR 0-1) and 2 (IQR 0-3) for protocol and non-protocol groups (p = 0.0001). There was no difference in the incidence of hypokalemia, hypoglycemia, or cerebral edema.CONCLUSIONS:The protocol did not change time to normalization of ketoacidosis but did decrease the duration of insulin therapy, number of adjustments to insulin drip rate, and number of wasted IV fluid bags without increasing the incidence of adverse events.
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Megan
authors.initials: M
authors.lastname: Veverka
authors.affiliation: Physicians Regional Medical Center, Naples, Florida.
authors.forename: Kourtney
authors.initials: K
authors.lastname: Marsh
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Susan
authors.initials: S
authors.lastname: Norman
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Michael Alan
authors.initials: MA
authors.lastname: Brock
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Monica
authors.initials: M
authors.lastname: Peng
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shenk
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Jerome Gene
authors.initials: JG
authors.lastname: Chen
keywords: diabetes; diabetic ketoacidosis; hyperglycemia; insulin; pediatrics; two-bag system