Abstract
Background
The “two-bag method” of management of diabetic ketoacidosis (DKA) allows for titration
of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying
dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates
constant.
Objective
We aimed to evaluate the feasibility and potential benefits of this strategy in adult
emergency department (ED) patients with DKA.
Methods
This is a before-and-after comparison of a protocol using the two-bag method operationalized
in our adult ED in 2015. A retrospective electronic medical record search identified
adult ED patients presenting with DKA from January 1, 2013 to June 30, 2016. Clinical
and laboratory data, timing of medical therapies, and safety outcomes were collected
and analyzed.
Results
Sixty-eight patients managed with the two-bag method (2B) and 107 patients managed
with the one-bag method (1B) were identified. The 2B and 1B groups were similar in
demographics and baseline metabolic derangements, though significantly more patients
in the 2B group received care in a hybrid ED and intensive care unit setting (94.1%
vs. 51.4%; p < 0.01). 2B patients experienced a shorter interval to first serum bicarbonate ≥
18 mEq/L (13.4 vs. 20.0 h; p < 0.05), shorter duration of insulin infusion (14.1 vs. 21.8 h; p < 0.05), and fewer fluid bags were charged to the patient (5.2 vs. 29.7; p < 0.01). Frequency of any measured hypoglycemia or hypokalemia trended in favor of
the 2B group (2.9% vs. 10.3%; p = 0.07; 16.2% vs. 27.1%; p = 0.09; respectively), though did not reach significance.
Conclusions
The 2B method appears feasible for management of adult ED patients with DKA, and use
was associated with earlier correction of acidosis, earlier discontinuation of insulin
infusion, and fewer i.v. fluid bags charged than traditional 1B methods, while no
safety concerns were observed.
Keywords
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Article info
Publication history
Published online: April 05, 2018
Accepted:
January 6,
2018
Received in revised form:
December 15,
2017
Received:
August 23,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
