In this episode, I’ll discuss using one vs two bag protocols for the treatment of diabetic ketoacidosis.
In the management of diabetic ketoacidosis, it is essential to deliver isotonic IV fluids with additional electrolytes as well as dextrose. To accomplish this, one of two methods is generally used – a “one bag” method which has the dextrose, saline, and other electrolytes mixed together, and a “two bag” method that gives the dextrose separately.
In an effort to determine which of these methods is best, a group of authors published in Annals of Emergency Medicine a systematic review and meta-analysis looking at the Two-bag Versus One-bag Method for Adult and Pediatric Diabetic Ketoacidosis Management.
The authors included 9 adult and 12 pediatric studies in the analysis. The primary outcomes of interest were the incidence of hypoglycemia and the time to resolution of DKA.
There were over 3300 patients represented in the adult studies and over 1300 in the pediatric studies. The authors found that in both the adult and pediatric studies, the two-bag method was associated with reduced incidence of hypoglycemia with a risk ratio of 0.5 and a nearly 2-hour faster time to DKA resolution. In the adult-only population, the two-bag method was associated with a nearly 4-hour shorter duration of IV insulin infusion and a reduced incidence of hypokalemia with a risk ratio of 0.84.
The authors concluded:
The two-bag method is associated with reduced incidence of hypoglycemia and time to DKA resolution in both adult and pediatric populations.
While the one-bag method may seem more straightforward to implement, the two-bag method is associated with clinically meaningful improvements in outcomes for both adult and pediatric populations.
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.
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