University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada.
Can J Diabetes. 2016 Jun;40(3):204-9. doi: 10.1016/j.jcjd.2015.10.002. Epub 2016 Mar 9.
Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care.
We conducted a retrospective chart review to establish the prevalence of hypokalemia in patients diagnosed with DKA between July 2012 and July 2013. A focused root-cause analysis was subsequently performed to identify Canadian Diabetes Association DKA clinical practice guideline deviations and preventable errors that resulted in significant hypokalemia (K<3.3 mmol/L) during the first 48 hours of management. Clinical and management details were reviewed to determine the type, preventability and root cause(s) of each error.
We identified 40 cases of DKA during the study period. The overall prevalence of hypokalemia during DKA treatment was 38% (15/40), with 25% in type 1 and 56% in type 2 diabetes. Males were more likely to experience hypokalemia (87%), and 47% of hypokalemic incidents occurred in the first presentation of diabetes. All 10 cases of significant hypokalemia were reviewed. We identified 23 errors in 6 (60%) cases, of which 87% were deemed to be preventable. The most common errors were noncessation of insulin infusion during hypokalemia (60%), inadequate potassium supplementation (50%) and infrequent biochemical monitoring (50%).
Hypokalemia occurs frequently during acute DKA management and is often preventable. Our findings suggest that interventions targeted at enhancing awareness of guidelines may reduce hypokalemia rates.
低钾血症是糖尿病酮症酸中毒（DKA）治疗中经常出现的并发症，可能会产生严重后果，包括心律失常和死亡。我们评估了我院治疗 DKA 患者低钾血症的患病率及其相关因素，并确定了改善治疗的机会。
我们进行了回顾性病历审查，以确定 2012 年 7 月至 2013 年 7 月期间被诊断为 DKA 的患者中低钾血症的患病率。随后进行了重点根本原因分析，以确定加拿大糖尿病协会 DKA 临床实践指南偏差和可预防的错误，这些错误导致在管理的头 48 小时内出现严重低钾血症（K<3.3mmol/L）。审查临床和管理细节，以确定每个错误的类型、可预防性和根本原因。
我们在研究期间确定了 40 例 DKA 病例。在 DKA 治疗过程中，低钾血症的总体患病率为 38%（15/40），1 型糖尿病占 25%，2 型糖尿病占 56%。男性更有可能出现低钾血症（87%），47%的低钾血症发生在首次诊断糖尿病时。我们审查了所有 10 例严重低钾血症病例。在 6 例（60%）患者中发现了 23 个错误，其中 87%被认为是可以预防的。最常见的错误是在低钾血症期间未停止胰岛素输注（60%）、钾补充不足（50%）和生化监测不频繁（50%）。
低钾血症在急性 DKA 管理中经常发生，而且往往是可以预防的。我们的研究结果表明，针对增强对指南认识的干预措施可能会降低低钾血症的发生率。
