Pediatric Diabetic Ketoacidosis: Comparing Outcomes of Potassium Acetate Versus Potassium Chloride Using the Two-Bag...

Pediatric diabetic ketoacidosis (DKA) results in dehydration and electrolyte losses, but there is no standardized potassium salt form for repletion. The objective of this research was to assess time to resolution of ketoacidosis in DKA patients comparing different potassium salts in the 2-bag system during an electrolyte shortage.

A retrospective cohort study was performed to review pediatric cases that met the institution's criteria for DKA and were started on the 2-bag system. Patients were identified from use of a DKA order set within the electronic health record. Cases were excluded if a patient received both potassium acetate and chloride, deviated from the active protocol product or were transferred to/from another institution. Data collected included patient demographics, and laboratory values including blood glucose, beta-hydroxybutyrate, venous pH, serum bicarbonate, and serum potassium collected at presentation and then per protocol until resolution of DKA. Initial laboratory values were utilized to determine DKA severity. Statistical analysis included descriptive statistics, Kaplan-Meier analysis for time to resolution of DKA, Wilcoxon rank sum test for continuous non-parametric data, and χ² or Fisher exact test for nominal data.

A total of 124 cases were included: 62 in each cohort. There was a similar number of patients presenting with severe DKA in the potassium acetate group compared with the potassium chloride group (48.4% vs 51.6%). Cases in the potassium acetate group showed a median 48-minute faster time to DKA resolution than the potassium chloride group; this was not a statistically significant difference (p = 0.54). There was a statistically significant difference amongst the median length of stay between the potassium acetate and potassium chloride groups (43.7 hours vs 48.6 hours; p = 0.037). There was no noted mortality in either group.

There were no clinically significant differences in outcomes in pediatric DKA patients when comparing potassium acetate and potassium chloride in the 2-bag system.