Analysis of a DKA protocol: Laboratory tests and outcomes

Abstract

Most hospitals use protocols to manage diabetic ketoacidosis using laboratory criteria to monitor the response to insulin and fluid therapy. This study analyzed information collected prospectively on a group of patients with diabetic ketoacidosis to review outcomes and management details. The study included 37 patients with a mean age of 38.1 ± 18.5 years. The initial blood glucose was 546.4 ± 296.3 mg/dL. The initial anion gap was 31.8 ± 7.8 meq/L. The mean time to anion gap closure twice was 19.2 ± 12.8 hours. The mean fluid administered until anion gap closure was 3694.9 ± 2484.6 mL. The insulin dose during the first day of management was 69.5 ± 49.9 units; the mean number of point-of-care glucose levels during the first 24 hours was 21.2 ± 6. The number of basic metabolic panels collected during hospital management was 12.2 ± 13.7. The mean ICU length of stay was 2.5 ± 3.8 days with no mortality. This study indicates that patients with diabetic ketoacidosis had a large number of basic metabolic panel tests and a large number of point of care glucose measurements using this protocol. This protocol needs review to determine whether or not the number of tests can be reduced, and transfer out of the ICU can occur more quickly. Key words: Diabetic ketoacidosis, glucose levels, anion gap, basic metabolic panels, outcomes