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Journal of General and Emergency Medicine

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Research Article

Pilot Study of Guideline Adherence and Secondary Outcomes in Patients Presenting with Diabetic Ketoacidosis

Nancy Wei, Jiraporn Sri-on* and Shan Woo Liu

Correspondence Address :

Jiraporn Sri-on,
Emergency Department, Vajira Hospital,
Navamindrahiraj University,
Bangkok, Thailand, Tel: +66896840010,
Email: jiraporn.rew@gmail.com

Received on: February 10, 2017 , Accepted on: March 09, 017 , Published on: March 16, 017

Citation: Nancy Wei, Jiraporn Sri-on, Shan Woo Liu (2017). Pilot Study of Guideline Adherence and Secondary Outcomes in Patients Presenting with Diabetic Ketoacidosis

Copyright: 2017 Jiraporn Sri-on, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract
Background: The 2010 American Diabetic Association (ADA) Guidelines for management of diabetic ketoacidosis (DKA) recommend treatment of DKA in a timely manner. 
Objective: We sought to explore the quality of emergency department (ED) DKA management by comparing ED DKA management with standard ADA guidelines beyond the initial management. 
Materials and Methods: This study was a retrospective study at an academic ED. Patients age ≥ 18 years who were evaluated and treated for DKA were included. We compared ED DKA management with standard ADA guidelines in four aspects: (1) fluid administration, (2) insulin administration, (3) electrolyte correction, and (4) ED disposition. Secondary outcomes were hypoglycemia, restarting of continuous insulin infusion (CII), and rebound hyperglycemia within 24 hours.
Results: Of 75 enrolled patients, 29(39%) had mild, 16(21%) had moderate, and 30(40%) had severe DKA. All patients received intravenous fluid during their ED stay. Seventy five (100%) of cases received insulin administration in the ED. Twenty-four (44%) of cases received potassium supplement. Dextrose containing fluids was administered in 24/58(41%) of cases where blood glucose dropped <250 mg/dL. Only 14/30(47%) of severe DKA patients were admitted to ICU. Forty-six (61%) of the DKA cases treatment in the ED followed all components of the ADA guidelines. We found 12(16%) patients had hypoglycaemia. CII discontinued while still in the ED and restarted in 7/13(53%) of these patients. 
Conclusion: The ADA recommended guidelines were adhered to in only two third of the time. Further studies to assess the impact of educational programs and ED-specific DKA protocols beyond stabilization are planned.
Keywords: Diabetic ketoacidosis (DKA); Guideline adherence; Emergency department (ED)