Haas NL, et al. - Given the two-bag method (2B) 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, researchers tested this strategy with respect to feasibility and potential benefits in adult Emergency Department (ED) patients with DKA. Without safety concerns, 2B method vs traditional 1B methods offered earlier correction of acidosis, earlier discontinuation of insulin infusion, and fewer i.v. fluid bags charged in adult ED patients with DKA, and appeared feasible.

Methods

• Researchers carried out a before-and-after comparison of a protocol using the two-bag method operationalized in adult ED in 2015.
• They performed a retrospective electronic medical record search to identify adult ED patients presenting with DKA from January 1, 2013 to June 30, 2016.
• They gathered and analyzed clinical and laboratory data, timing of medical therapies, and safety outcomes.

Results

• They identified a total of 68 patients managed with the two-bag method (2B) and 107 patients managed with the one-bag method (1B).
• Similarity was noted in the demographics and baseline metabolic derangements between the 2B and 1B groups, though care in a hybrid ED and intensive care unit setting was received by significantly more patients in the 2B group (94.1% vs 51.4%; p< 0.01).
• Treatment with 2B method resulted in 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 charged to the patient (5.2 vs 29.7; p < 0.01).
• Data revealed that though not significant, 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).