In this episode, I’ll discuss how to predict failure of insulin transition in critically ill patients with diabetic ketoacidosis.
When patients with diabetic ketoacidosis (DKA) are treated with IV insulin and then develop a normal anion gap, standard practice is to transition the patient to subcutaneous insulin. This transition is essential to make on a timely basis because patients receiving IV insulin require more nursing resources. However, some patients fail this transition and develop recurrent DKA, requiring resumption of IV insulin and a transfer back to a higher level of care. The ability to predict which patients might fail this transition can help prevent otherwise avoidable transfers back to the ICU.
Of the nearly 100 patients analyzed for the study, patients who developed a normal anion gap but had a serum bicarbonate of 16 mEq/L or less were significantly more likely to experience a transition failure. The odds ratio for this sign was 4.74 and the difference was statistically significant.
This study provides a potential method for identifying DKA patients at risk of failing the transition to subcutaneous insulin and should provide the impetus for further study in a larger population.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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