Current Treatment of DKA: A Review and Approach to Establishing a Best Practice Protocol
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Diabetic ketoacidosis (DKA) is a life threatening complication of diabetes, with profound implications for patients and the healthcare system. Effective treatment of DKA depends on early diagnosis and initiation, followed by timely and accurate monitoring of the disease process. Emphasis was placed on how to manage DKA efficiently, to decreased patient length of stay, without compromising patient safety. This article addresses the underutilization of point of care beta-hydroxybuteric acid (βOHB) meters for diagnostic and treatment guidance. The use, and safety, of point of care βOHB meters for diagnostic and treatment guidance are examined. Improved utilization of such devices may present an opportunity to improve patient outcomes and decrease patient lengths of stay. Methods: Using Scopus, PubMed, and Google Scholar search engines, a review of English, peer reviewed literature of the past 10 years on the diagnosis and management of DKA was constructed. Careful consideration has allowed recommendations presented here to be in agreement with the Canadian Diabetic Association's Clinical Practice Guidelines. A best practice protocol order set was produced; ready for implementation at WRHA community hospitals. Results and Recommendations: Effective treatment of DKA requires early diagnosis, fluid and electrolyte repletion, insulin therapy, and constant monitoring. Treatment strategies have been researched with the goal of diminishing patient length of stay without compromising patient safety. Conclusion: Recommended DKA treatments presented here are optimized when such treatments involve the use βOHB meters for diagnosis and management of DKA. As well it is recommended that treatment strategies be directed via up to date best evidence protocol order sets. There is evidence that such order sets in conjunction with the use of such meters will provide a cost and safety benefit to hospitals and patients respectively.