Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Pharmacy, Emergency Medicine
Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar Nonketotic Coma
Purpose: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) are acute complications of diabetes. DKA and HHS require immediate fluid resuscitation, blood glucose reduction, electrolyte management, and correction of metabolic abnormalities. Standardized protocols for the management of DKA and HHS decrease time to resolution of hyperglycemia, metabolic derangements, rebound hyperglycemic crises, and length of stay without increasing iatrogenic complications. A two-phase protocol for the management of DKA/HHS was implemented at our institution in 2015. The purpose of our study is to characterize the utilization, effectiveness, and safety of our DKA/HHS protocol.
Methods: A retrospective chart review will be conducted on three hundred patients who received the DKA/HHS protocol at our institution from January 1st, 2018 through December 31st, 2018. Patients will be included if they were 18 years of age or older and were initiated on the protocol. Patients will be excluded if pregnant, management was initiated at an outside hospital, or if diagnosed with euglycemic DKA secondary to an SGLT-2 inhibitor. The following data will be collected: age, gender, weight, pertinent past medical history, suspected precipitating event, and length of stay. To categorize DKA/HHS we will collect initial blood glucose, serum pH, serum bicarbonate, serum potassium, anion gap, and presence of ketones. The primary effectiveness outcome is time to DKA or HHS resolution. DKA resolution is defined as a blood glucose less than 200 mg/dL and two of the following: anion gap less than 16, pH greater than 7.3, and serum bicarbonate greater than or equal to 15 mEq/L. HHS resolution is defined as a serum osmolarity less than or equal to 320 mOsm/kg. The secondary effectiveness outcome is incidence of DKA or HHS relapse. Safety outcomes include incidence of hypoglycemia, severe hypoglycemia, emergent treatment of hypoglycemia, incidence of hypokalemia during infusion, incidence of hypophosphatemia, and incidence of hypomagnesemia.
Vitale, Gianna; Rolfe, Stephen; Bierlein, Joleen; and Corica, Erin, "Evaluation of an institutionspecific protocol for hyperglycemic crises management" (2020). Costas T. Lambrew Research Retreat 2020. 105.