Abstract #211 Analysis of a Community Hospital’s Diabetic Ketoacidosis Management Protocol

Gestational hypertriglyceridemia is well established but is considered an unusual cause of acute pancreatitis with a relatively low incidence. We hereby report a notable triad of hypertriglyceridemia, diabetic ketoacidosis and acute pancreatitis in a woman with 2 months of post-partum status delivered at a private hospital with known case of gestational diabetes mellitus. Presenting with acute abdomen with a surprise on table. Salmon pink coloured blood withdrawn in the vacutainer, turning lactescent post centrifugation. Her serum triglycerides level were 1750 mg/dl, random blood sugar of 870 mg/dl and total cholesterol of 978 mg/dl. Computerized tomography of abdomen was confirmatory of acute pancreatitis. Patient was treated aggressively with intravenous (IV) fluid resuscitation and IV insulin therapy as per diabetic ketoacidosis (DKA) management protocol. She recovered well and was discharged on day 4.

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A medical audit on management protocol of Diabetic Ketoacidosis in EMW

Annals of King Edward Medical University ◽

10.21649/akemu.v12i1.861 ◽

2016 ◽

Vol 12 (1) ◽

Author(s):

Umair Javaid Chaudhary ◽

Sajid Abaidullah ◽

Jawad Zaheer ◽

Anjum Razzaq ◽

Zafar Niaz ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Blood Sugar ◽

Blood Sugar Level ◽

Blood Gases ◽

Medical Audit ◽

Serum Electrolytes ◽

Arterial Blood ◽

Audit Data ◽

Management Protocol ◽

Initial Blood

A retrospective medical audit was conducted on patients admitted in East Medical Ward from January 2004 to July 2005 with a diagnosis of diabetic ketoacidosis. There were 44 patients included in this audit. Patients who had initial blood sugar level more than 250mg/dl and later found to have negative urinary ketones were excluded from the audit. Data was collected on a predesigned proforma and was analysed by the programme SPSS version 10. Results: We found that mean age of the patients was 35.39 18.26 years including 21 (47.7%) males and 23 (52.3%) females. Fourteen (31.8%) patients had their first presentation as diabetic ketoacidosis where as rest of the patients were known diabetics including 56.8% diabetic for less than 10 years and 11.4% diabetic for more than 10 years. Blood sugar level of all the patients was checked at presentation and none of them had blood sugar level less than 250mg/dl and record was missing for 3 patients. Urinary ketones of 44 patients were found to be positive with a max.no. 20 (45.5%) having 4+ ketones where as 3 had their record missing. We found that out of 44 patients arterial blood gases record of 36 (81.8%) patients was available ( mean pH = 7.0786,mean pCO2 = 22.231, mean HCO3 = 12.867) and 8 (18.2%) had their record missing. Serum electrolytes investigation record showed that 11 (25%) patients had their record missing for serum Na+ and K+. Rest of the patients had their record available in which serum Na+ ranged from 131 to 151 mEq/L where as serum K+ values showed that only 1(2.3%) patient had hyperkalemia (serum K+ >5.5) and 4(9.1%) had hypokalemia (serum K+ <3.5).

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Abstract #1221: Improvement in Clinical Outcomes Following Implementation of a Diabetic Ketoacidosis Management Protocol

Endocrine Practice ◽

10.1016/s1530-891x(20)42450-4 ◽

2015 ◽

Vol 21 ◽

pp. 284-285

Author(s):

Iva Neupane ◽

Susan George ◽

Nitin Trivedi

Keyword(s):

Diabetic Ketoacidosis ◽

Clinical Outcomes ◽

Management Protocol

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Use of a standardised diabetic ketoacidosis management protocol improved clinical outcomes

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2014.01.016 ◽

2014 ◽

Vol 104 (1) ◽

pp. e8-e11 ◽

Cited By ~ 21

Author(s):

Moe Thuzar ◽

Usman H. Malabu ◽

Ben Tisdell ◽

Kunwarjit S. Sangla

Keyword(s):

Diabetic Ketoacidosis ◽

Clinical Outcomes ◽

Management Protocol

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Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002451 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002451

Author(s):

Emma Ooi ◽

Katrina Nash ◽

Lakshmi Rengarajan ◽

Eka Melson ◽

Lucretia Thomas ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Tertiary Care ◽

Final Analysis ◽

Care Hospital ◽

Hospital Data ◽

Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

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A Pediatric Diabetic Ketoacidosis Management Protocol Incorporating a Two-Bag Intravenous Fluid System Decreases Duration of Intravenous Insulin Therapy

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.6.512 ◽

2016 ◽

Vol 21 (6) ◽

pp. 512-517 ◽

Cited By ~ 1

Author(s):

Megan Veverka ◽

Kourtney Marsh ◽

Susan Norman ◽

Michael Alan Brock ◽

Monica Peng ◽

...

Keyword(s):

Intensive Care Unit ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Diabetic Ketoacidosis ◽

Median Number ◽

Process Efficiency ◽

Fluid System ◽

Intravenous Insulin ◽

Management Protocol

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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