scholarly journals A reaudit testing the adherence to the local trust protocol detected delay in potassium replacement during acute management of diabetic ketoacidosis

2021 ◽  
Vol 75 (11) ◽  
Author(s):  
Emmanuel Ssemmondo ◽  
Hui Hwen Wong ◽  
Sonia Moteea ◽  
Anis Abobaker ◽  
Tadeusz Pawlak
Keyword(s):  
Diabetic Ketoacidosis ◽  
Acute Management ◽  
Potassium Replacement

Electrocardiogram as a Guide to Potassium Replacement in Diabetic Ketoacidosis

Diabetes ◽  
1974 ◽  
Vol 23 (7) ◽  
pp. 610-615 ◽  
Author(s):  
N. G. Soler ◽  
M. A. Bennett ◽  
M. G. Fitzgerald ◽  
J. M. Malins
Keyword(s):  
Diabetic Ketoacidosis ◽  
Potassium Replacement

Potassium Concentration in Initial Fluid Therapy and In-Hospital Mortality of Patients with Diabetic Ketoacidosis

2021 ◽  
Author(s):  
Akira Okada ◽  
Hayato Yamana ◽  
Kojiro Morita ◽  
Yukihito Sato ◽  
Satoko Yamaguchi ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Diabetic Ketoacidosis ◽  
Fluid Therapy ◽  
Odds Ratio ◽  
Potassium Concentration ◽  
Kidney Dysfunction ◽  
Diagnosis Procedure Combination ◽  
Cut Points ◽  
Multivariable Regression ◽  
Potassium Replacement

Abstract Context Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality. Objective We aimed to determine the association between infused potassium concentration and in-hospital mortality. Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia. Results We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further. Conclusion Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality.

scholarly journals Treatment of Pediatric Diabetic Ketoacidosis in Canada: A Review of Treatment Protocols from Canadian Pediatric Emergency Departments

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Steven A Skitch ◽  
Rahim Valani
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Treatment Guidelines ◽  
Treatment Protocol ◽  
Serum Glucose ◽  
National Guidelines ◽  
Fluid Bolus ◽  
Treatment Protocols ◽  
Maintenance Fluid ◽  
Potassium Replacement

ABSTRACTObjectiveDiabetes is the most common pediatric endocrine disorder, and diabetic ketoacidosis (DKA) is the leading cause of diabetes-related morbidity and mortality. This article reviews pediatric DKA treatment protocols from across Canada and identifies similarities and differences.MethodsPediatric tertiary centres in Canada were asked for a copy of their DKA treatment protocol. For each protocol, we collected information on the amount of initial fluid bolus, maintenance fluid rate, insulin infusion rate, potassium replacement, monitoring and adjustment for serum glucose, administration of bicarbonate, and treatment for cerebral edema.ResultsResponses were obtained from 13 sites. Treatment guidelines were consistent in their recommendations on timing and dosage of intravenous insulin, potassium replacement, monitoring and adjusting for serum glucose, and management of cerebral edema. Variability in treatment protocols was found chiefly in volume of initial fluid bolus (range: 5–20 mL/kg) and length of time boluses should be administered (20–120 min), maintenance fluid rates (based on weight or a 48-hr deficit), and the role of bicarbonate administration.ConclusionsThis is the first review of treatment protocols for pediatric DKA in Canada. It identified many common approaches but noted specific differences in fluid boluses, maintenance fluid rates, and bicarbonate administration. The extent of variation indicates the need for further study, as well as national guidelines that are evidence-based and consistent with best practices.

scholarly journals Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

2018 ◽  
Author(s):  
Aleksandra Cieluch ◽  
Aleksandra Uruska ◽  
Bogusz Falkowski ◽  
Magdalena Błońska ◽  
Paweł Niedźwiecki ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Potassium Replacement

The Management of Diabetic Ketoacidosis

2007 ◽  
Vol 6 (1) ◽  
pp. 3-8
Author(s):  
JA Edge ◽  
◽  
MS Hammersley ◽  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Distress Syndrome ◽  
Cerebral Oedema ◽  
Basic Principles ◽  
Intravenous Insulin ◽  
National Guidance ◽  
Life Threatening ◽  
Principles Of Treatment ◽  
Potassium Replacement ◽  
Beta Hydroxybutyrate

This article reviews the management of diabetic ketoacidosis (DKA) in adults with a focus on the three basic principles of treatment: intravenous fluid therapy, intravenous insulin administration and potassium replacement. The recommendations are modelled on the national guidance for the management of DKA in children. We highlight the importance of being alert to signs of life-threatening complications of the condition such as cerebral oedema and adult respiratory distress syndrome (ARDS). We also discuss the use of near-patient testing of capillary beta-hydroxybutyrate (b-OHB) using a ketone meter as an aid to managing and preventing DKA.

Acute Management of Pediatric Diabetic Ketoacidosis

MedEdPORTAL ◽  
2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Janine Zee-Cheng ◽  
Alexander Djuricich ◽  
Emily Webber ◽  
Samer Abu-Sultaneh
Keyword(s):  
Diabetic Ketoacidosis ◽  
Acute Management

Prospective Randomized Trial of Insulin Glargine in Acute Management of Diabetic Ketoacidosis in the Emergency Department: A Pilot Study

2015 ◽  
Vol 22 (6) ◽  
pp. 657-662 ◽  
Author(s):  
Pratik Doshi ◽  
Andrew J. Potter ◽  
Daniel De Los Santos ◽  
Rosa Banuelos ◽  
Bryan F. Darger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Insulin Glargine ◽  
Randomized Trial ◽  
Diabetic Ketoacidosis ◽  
Prospective Randomized Trial ◽  
Acute Management
Sign in / Sign up

Export Citation Format

Share Document