Issue 126 Item 4 Aggressive Management is Key to Rapid Recovery for Diabetic Ket

Aggressive management of diabetic ketoacidosis in the emergency department (ED) can quickly correct associated hyperglycemia and metabolic acidosis. That, according to a study presented here at the Scientific Assembly 2002 American College of Emergency Physicians (ACEP).

The finding suggests that aggressive ED management is paramount to recovery, the researchers say.

Lala Dunbar, MD, PhD, and colleagues from Louisiana State University Health Services Center, in New Orleans, Louisiana, United States, conducted a retrospective review of all patients with diabetic ketoacidosis treated in the ED from January 1994 to March 1995.
They identified 40 men and 20 women, mean age 34.5 years, and measured initial serum pH, PCO2, HCO3, and glucose as well as final emergency department HCO3, glucose, and disposition to intensive care unit (ICU) or medical unit.

Fourteen patients were admitted to the ICU after being treated in the ED for a mean of 9.8 hours. During the ED stay the mean correction of glucose was 510 mg/dL, with a mean glucose level of 308 mg/dL on admission to ICU. Serum HCO3 levels rose a mean of 6.3 mEq/L to a mean of 12.9 mEq/L.

Mean length of ED stay for the 46 patients admitted to the medical floor was 12.9 hours, at which time their mean glucose level was corrected by 406 mg/dL to a mean of 244mg/dL, and their serum HCO3 increased by 6.9 mEq/L to a mean of 19.9 mEq/L.

The results suggest that aggressive ED management can achieve similar rates of glucose correction in patients who are nonketotic, hyperglycemic and who undergo ED observation and treatment, Dr. Dunbar said. He is now conducting a prospective study to document these reported outcomes.