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
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)