Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI:10.1016/j.jemermed.2024.10.013

Gulser Esen Besli MD , Merve Nur Hepokur MD , Sibel Ergin Sahin MD , Asan Onder MD , Metin Yildiz MD , Irem Bulut MD , Hamdi Cihan Emeksiz MD

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引用次数: 0

Abstract

Background

The standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center.

Objectives

To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes.

Methods

This retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes.

Results

Out of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (p = 0.007, p < 0.001, respectively), higher correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001, respectively), shorter duration of IV insulin treatment (p = 0.008), more appropriate potassium dosage administrating to IV fluids (p < 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036, respectively), and smaller number of IV bags use (p < 0.001).

Conclusion

Implementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.

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三级护理儿科急诊科糖尿病酮症酸中毒治疗方案的实施和结果

背景：规范糖尿病酮症酸中毒（DKA）急诊治疗的临床实践是提高患者护理水平的前提。为此，自2020年1月起，我中心实施了包含两袋系统的标准化DKA协议。目的：评估DKA标准治疗途径的开发和利用对患者预后的影响。方法：本回顾性队列研究纳入诊断为DKA并在儿科急诊科（PED）住院的患者。整个研究期间为2017年1月至2022年9月。在实施方案之前和之后比较DKA患者的临床结果。结果：145例患者中，方案前组77例（53%），方案组68例（47%）。两组患者的年龄、性别和DKA严重程度相似。该方案的实施缩短了酸中毒和酮症的解决时间（p = 0.007, p < 0.001），提高了碳酸氢盐和血酮的校正率（p = 0.003, p < 0.001），缩短了静脉胰岛素治疗的持续时间（p = 0.008），更合适的静脉输液钾剂量（p < 0.001），降低了低钾血症、低磷血症和低血糖的发生率（p = 0.008, p = 0.002, p = 0.036）。静脉输液袋使用次数较少（p < 0.001）。结论：实施基于协议的DKA途径，包括双袋系统，可以早期纠正酮症酸中毒，降低并发症的风险，并减少PED的资源利用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine