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Published on: June 11, 2012
Impact of a hyperglycemic crises protocol
Jayme S Hara1, Aryan J Rahbar, Meghan N Jeffres
1Department of Pharmacy, Methodist University Hospital, Memphis, TN Department of Pharmacy, University Medical Center of Southern Nevada, Las Vegas, Nevada.
Summary
A new protocol for adult hyperglycemic crises, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), significantly reduced treatment times. This improved protocol did not increase risks of hypoglycemia or hypokalemia.
Area of Science:
- Endocrinology
- Internal Medicine
- Critical Care Medicine
Background:
- Hyperglycemic crises, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), are serious diabetes complications requiring prompt and effective management.
- Existing treatment protocols may vary, leading to potential inconsistencies in patient care and outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a standardized adult hyperglycemic crises protocol.
- To assess the protocol's impact on time to resolution and patient length of stay.
- To determine if the protocol affects the incidence of hypoglycemia and hypokalemia.
Main Methods:
- A retrospective review was conducted comparing patients treated before and after the implementation of a new hyperglycemic crises protocol.
- A total of 256 adult patients with DKA or HHS treated with insulin infusion were analyzed (nonprotocol n=143, protocol n=113).
- Efficacy was measured by time to DKA/HHS resolution, ICU length of stay (LOS), and hospital LOS. Safety was assessed by monitoring hypoglycemic and hypokalemic events.
Main Results:
- The protocol group showed a significant reduction in time to resolution by 9.2 hours (P<.001), with protocol patients resolving in 13.58 hours versus 22.78 hours for nonprotocol patients.
- No significant differences were observed in safety outcomes, including rates of moderate hypoglycemia (blood glucose <70 mg/dL), severe hypoglycemia (blood glucose <50 mg/dL), or hypokalemia (K+ <3.3 mmol/L).
Conclusions:
- Implementation of the hyperglycemic crises protocol effectively decreased the time to resolution for DKA and HHS.
- The protocol demonstrated a favorable safety profile, not increasing the incidence of hypoglycemia or hypokalemia.
- This standardized approach offers a safe and efficient method for managing adult hyperglycemic crises.
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