Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

Abstract

Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management. Nonadherence to the protocol was defined as too low or too high doses of potassium compared with the recommended potassium replacement protocol. Results The median duration of DKA treatment was longer in the nonadherent group than in the adherent group: 37 hours (interquartile range [IQR], 27-48) and 30 hours (IQR, 17-43), respectively (P = 0.005). Treatment duration correlated positively with nonadherence to potassium replacement protocol (r = 0.18; P = 0.005) and severity of DKA (r = 0.52; P <0.0001). Stepwise multivariate linear regression analysis indicated nonadherence to the protocol (β = 0.14; P = 0.02) and severity of DKA (β = 0.43; P <0.0001) as predictors of treatment duration, after adjustment for body mass index and age (R2 = 0.28; P <0.0001). Conclusions Nonadherence to potassium replacement protocol leads to prolongation of DKA management. Medical staff should be educated about the benefits of potassium replacement and precision in potassium administration and dosing in patients with DKA.

<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

“…The extent of non-adherence to the treatment protocol for the management of DKA is also a reason for hypokalemic events 76. Abela et al56 reported that potassium was given to the patients at a later stage of DKA resolution, with the main reasons being lack of clear instructions or secondary to not following the DKA management protocol to analyze the blood for potassium concentration; importantly, the volume of potassium resuscitation was higher and aggressive when initiated.…”

“…Although the well established guidelines strongly give recommendations regarding potassium monitoring and supplementation in DKA, none of these guidelines suggest using the pH-adjusted corrected potassium level to initiate potassium resuscitation or adjust the treatment plan 4–7. And on top of it, count to carry out the recommendations for potassium resuscitation remains very low, regardless of time, whether it is observed in the distant9,48,54,56,71 or near past 76. Even further, despite all the included studies in the current review that were either depicting important parameters of DKA or experimenting with its management to improve patient oriented outcomes, not a single study demonstrated the impact of potassium and acidosis on cardiovascular outcomes in DKA patients, which remains an area to explore further.…”

Hyperglycaemic crises in adults with diabetes: a consensus report

“…To avoid hypokalaemia, we recommend measuring serum potassium 2 h after starting insulin administration and every 4 h thereafter until the resolution of DKA. Use of too low or too high doses of potassium compared with the recommended potassium replacement protocols in the management of DKA has been associated with longer hospital stays [148].…”

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report

“…To avoid hypokalemia, we recommend measuring serum potassium 2 h after starting insulin administration and every 4 h thereafter until the resolution of DKA. Use of too low or too high doses of potassium compared with the recommended potassium replacement protocols in the management of DKA has been associated with longer hospital stays (148).…”