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Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric

Gulser Esen Besli1, Merve Nur Hepokur2, Sibel Ergin Sahin2

  • 1Faculty of Medicine, Istanbul Medeniyet University, Üsküdar, İstanbul, Turkey; Department of Pediatric Emergency Medicine, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey.

The Journal of Emergency Medicine
|February 23, 2025
PubMed

Insights

A standardized diabetic ketoacidosis (DKA) protocol significantly improved patient outcomes by accelerating treatment and reducing complications. This pathway led to faster recovery and more efficient resource use in the pediatric emergency department.

Area of Science:

  • Pediatric Endocrinology
  • Emergency Medicine
  • Clinical Protocol Development

Background:

  • Standardizing clinical practice for diabetic ketoacidosis (DKA) is crucial for enhancing patient care.
  • A standardized DKA protocol, featuring a two-bag system, was implemented in January 2020 to improve treatment consistency.

Purpose of the Study:

  • To evaluate the impact of a standardized DKA treatment pathway on patient outcomes.
  • To assess the effectiveness of a new protocol in managing pediatric DKA cases.

Main Methods:

  • Retrospective cohort study comparing patients before and after protocol implementation (January 2017 - September 2022).
  • Analysis of clinical outcomes in a pediatric emergency department (PED) setting.
  • Involved 145 patients diagnosed with DKA, with 77 in the pre-protocol group and 68 in the protocol group.

Main Results:

  • Shorter resolution times for acidosis and ketosis observed with the protocol (p = 0.007, p < 0.001).
  • Improved correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001).
  • Reduced incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036) and fewer IV bags used (p < 0.001).

Conclusions:

  • Protocol-based DKA management using a two-bag system leads to earlier ketoacidosis correction.
  • The standardized pathway decreases the risk of DKA-related complications.
  • Implementation resulted in more efficient resource utilization within the pediatric emergency department.
Abstract

Keywords:
ChildrenDiabetic ketoacidosisOutcomeProtocol-based treatmentTwo-bag fluid system

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