Potassium-Containing Fluids for Diabetic Ketoacidosis

Area of Science:

• Pediatric Emergency Medicine
• Clinical Pharmacy
• Process Improvement

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes requiring prompt treatment.
• Intravenous (IV) fluid potassium concentration is a critical component of DKA management.
• Standardizing IV fluid potassium concentrations can optimize treatment protocols.

Purpose of the Study:

• To determine the most utilized potassium concentration in IV fluids for DKA treatment at Children's Hospital of The King's Daughters (CHKD).
• To inform stocking decisions for IV fluids used in the Emergency Department (ED).

Main Methods:

• Retrospective chart review of patients aged ≤21 years with laboratory-confirmed DKA from July 2018 to June 2019.
• Primary outcome: most used potassium concentration (20 mEq/L vs. 40 mEq/L).
• Secondary outcomes: protocol adherence, goal serum potassium achievement, fluid administration time, and point-of-care (POC) vs. basic metabolic panel (BMP) potassium comparison.

Main Results:

• Of 113 patients, 64.6% received 40 mEq/L potassium IV fluids, while 35.4% received 20 mEq/L.
• 89.4% of fluids were ordered appropriately per DKA protocol.
• 52.5% of patients achieved goal serum potassium concentration.
• No significant difference in time from order to administration; significant difference in POC vs. BMP potassium measurements.

Conclusions:

• The 40 mEq/L potassium concentration was the most frequently administered IV fluid for DKA treatment.
• CHKD pharmacy should stock 40 mEq/L potassium IV fluids to align with clinical practice and optimize DKA management.