You are here

  • Home
  • Archive
  • Volume 5, Issue 1
  • Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

Article Text

Article menu

Download PDFPDF

XML
Epidemiology/Health Services Research
Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis
  1. Iqbal Munir1,
  2. Ramiz Fargo1,
  3. Roger Garrison1,
  4. Almira Yang1,
  5. Andy Cheng2,
  6. Ilho Kang1,
  7. Ali Motabar1,
  8. Karen Xu3,
  9. Lawrence K Loo2,
  10. Daniel I Kim1
  1. 1 Department of Medicine, Riverside University Health System Medical Center, Moreno Valley, USA
  2. 2 Department of Medicine, Loma Linda University Medical Center, California, USA
  3. 3 Department of Statistics, UCR School of Medicine, Riverside, USA
  1. Correspondence to Dr Iqbal Munir; i.munir{at}ruhealth.org

Abstract

Objective We compared the conventional ‘one-bag protocol’ of management of diabetic ketoacidosis (DKA) with the ‘two-bag protocol’ which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the other containing the same solution with the addition of 10% dextrose.

Research design and methods A retrospective chart review and analysis was done on adult patients admitted for DKA to the Riverside University Health System Medical Center from 2008 to 2015. There were 249 cases of DKA managed by the one-bag system and 134 cases managed by the two-bag system.

Results The baseline patient characteristics were similar in both groups. The anion gap closed in 13.56 hours in the one-bag group versus 10.94 hours in the two-bag group (p value <0.0002). None of the individual factors significantly influenced the anion gap closure time; only the two-bag system favored earlier closure of the anion gap. Plasma glucose levels improved to <250 mg/dL earlier with two-bag protocol (9.14 vs 7.82 hours, p=0.0241). The incidence of hypoglycemic events was significantly less frequent with the two-bag protocol compared with the standard one-bag system (1.49% vs 8.43%, p=0.0064). Neither the time to improve serum HCO3 level >18 mg/dL nor the hospital length of stay differed between the two groups.

Conclusions Our study indicates that the two-bag protocol closes the anion gap earlier than the one-bag protocol in adult patients with DKA. Blood glucose levels improved faster with the two-bag protocol compared with the one-bag protocol with fewer associated episodes of hypoglycemia. Prospective studies are needed to evaluate the clinical significance of these findings.

  • DKA

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2017-000395

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors IM researched, analyzed and interpreted the data; drafted and revised the manuscript for important intellectual content; and approved the final draft of the manuscript. RF, LL, DK, CG, AM and IK helped to analyze, and interpret the data; reviewed and revised the manuscript for important intellectual content; and approved the final version of the manuscript submitted. AY and AC helped to acquire and interpret the data; reviewed the manuscript for important intellectual content; and approved the final version of the manuscript submitted. KX performed the statistical analysis, reviewed the manuscript for important intellectual content, and approved the final version of the manuscript submitted.

    • Competing interests None declared.

    • Ethics approval Institutional Review Board of RUHS Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Further details of the data and analysis for this study could be obtained by contacting the corresponding author (IM) of this manuscript. They have included almost all the data generated for this study in the manuscript. They did not include data of anion gap closure and serum bicarbonate improvement according to the severity of DKA (severity based on only admission serum bicarbonate level).