Table 4

Review of the published studies on the two-bag diabetic ketoacidosis protocol

ReferenceStudy designHospital settingPatientsOutcome measure
Grimberg et al 21 Retrospective case–controlSingle center inpatient—Philadelphia, Pennsylvania20 pediatric patients (mean age 12–13):
10 one-bag, 10 two-bag
Two-bag system decreased number of intravenous bags used, response time by nursing to make changes in intravenous fluids, and costs of intravenous fluid therapy
Poirier  et al 23 Prospective non-blinded clinical trialSingle-center pediatric emergency room—Norfolk, Virginia33 pediatric patients (mean age 11–14):
16 one-bag,
17 two-bag
Two-bag system decreased the time for nursing to make changes in intravenous fluids
No difference in blood glucose or bicarbonate correction nor the number of intravenous bags used
So and Grunewalder et al 22 Retrospective seriesSingle-center inpatient— Greensboro, North Carolina31 pediatric patients (mean age 13–14):
9 one-bag, 22 two-bag
Two-bag system corrected bicarbonate and ketone levels faster
No time difference for blood glucose and pH correction
Current series 2010–2015Retrospective cohortSingle-center inpatient— Riverside, California383 adult patients (mean age 36–37):
249 one-bag
134 two-bag
Two-bag system closed the anion gap faster (10.94 vs 13.56 hours)
No significant time difference in hospital length of stay