Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
J Intensive Care Med. 2023 Jul;38(7):668-674. doi: 10.1177/08850666231175387. Epub 2023 May 11.
To compare key resource utilization and safety outcomes of adult emergency department (ED) patients in diabetic ketoacidosis (DKA) managed via the Two-Bag or traditional One-Bag method.
This is a retrospective review at an academic medical center ED. Patients were included if >18 years, met diagnostic criteria for DKA (pH ≤ 7.30, bicarbonate ≤ 18 mmol/L, anion gap ≥ 10), and were managed via a standardized order set (either Two-Bag or One-Bag Method). Comparisons used independent-groups -tests for continuous variables and χ tests for binary variables.
We identified 634 patients with DKA managed via the Two-Bag method, and 107 managed via the One-Bag method. Cohorts were similar in demographics and presenting laboratories. The Two-Bag Method was associated with 8.1 h shorter to first bicarbonate >18 mmol/L (11.9 vs 20.0, < .001), and 24 fewer IV fluid bags (5.3 vs 29.7, < .001). Incidence of hypokalemia (potassium <3.0 mmol/L) was 53% lower in the Two-Bag cohort (6.6 vs 14.0%, = .03); incidence of hypoglycemia (glucose <70 mg/dL) was 5.8 versus 10.3%, = .16.
For adult ED patients in DKA, the Two-Bag Method was associated with faster resolution of acidosis, fewer IV fluid bags charged, lower incidence of hypokalemia, and trend toward lower incidence of hypoglycemia compared to the One-Bag Method.
比较经两袋法和传统单袋法治疗的成人急诊科（ED）糖尿病酮症酸中毒（DKA）患者的关键资源利用和安全性结局。
这是一项在学术医疗中心 ED 进行的回顾性研究。纳入标准为年龄＞18 岁、符合 DKA 诊断标准（pH≤7.30、碳酸氢盐≤18mmol/L、阴离子间隙≥10）且采用标准化医嘱集（两袋法或单袋法）治疗的患者。采用独立样本 t 检验比较连续变量，采用卡方检验比较二分类变量。
我们共纳入 634 例经两袋法和 107 例经单袋法治疗的 DKA 患者。两组患者在人口统计学特征和就诊实验室指标方面相似。与单袋法相比，两袋法首次碳酸氢盐＞18mmol/L 的时间缩短 8.1 小时（11.9 比 20.0，＜0.001），静脉输液袋数减少 24 个（5.3 比 29.7，＜0.001）。两袋法低钾血症（血钾＜3.0mmol/L）发生率降低 53%（6.6 比 14.0%，=0.03），低血糖症（血糖＜70mg/dL）发生率降低 5.8%（5.8 比 10.3%，=0.16）。
对于成人 ED 中 DKA 患者，与单袋法相比，两袋法可更快纠正酸中毒、减少静脉输液袋数、降低低钾血症发生率，并降低低血糖症发生率的趋势。
