A pediatric diabetic ketoacidosis management protocol incorporating a two-bag intravenous fluid system decreases duration of intravenous insulin therapy

Megan Veverka, Kourtney Marsh, Susan Norman, Michael Alan Brock, Monica Peng, Jennifer Shenk, Jerome Gene Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)512-517
Number of pages6
JournalJournal of Pediatric Pharmacology and Therapeutics
Volume21
Issue number6
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Diabetic Ketoacidosis
Insulin
Pediatrics
Ketosis
Clinical Protocols
Therapeutics
Child Mortality
Hypokalemia
Incidence
Brain Edema
Type 1 Diabetes Mellitus
Hypoglycemia
Intensive Care Units
Retrospective Studies
Morbidity

Keywords

  • Diabetes
  • Diabetic ketoacidosis
  • Hyperglycemia
  • Insulin
  • Pediatrics
  • Two-bag system

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

Cite this

A pediatric diabetic ketoacidosis management protocol incorporating a two-bag intravenous fluid system decreases duration of intravenous insulin therapy. / Veverka, Megan; Marsh, Kourtney; Norman, Susan; Brock, Michael Alan; Peng, Monica; Shenk, Jennifer; Chen, Jerome Gene.

In: Journal of Pediatric Pharmacology and Therapeutics, Vol. 21, No. 6, 01.11.2016, p. 512-517.

Research output: Contribution to journalArticle

Veverka, Megan ; Marsh, Kourtney ; Norman, Susan ; Brock, Michael Alan ; Peng, Monica ; Shenk, Jennifer ; Chen, Jerome Gene. / A pediatric diabetic ketoacidosis management protocol incorporating a two-bag intravenous fluid system decreases duration of intravenous insulin therapy. In: Journal of Pediatric Pharmacology and Therapeutics. 2016 ; Vol. 21, No. 6. pp. 512-517.
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AU - Shenk, Jennifer

AU - Chen, Jerome Gene

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AB - 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.

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