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 and develop a normal anion gap, common practice is to transition the patient to subcutaneous insulin. However some patients fail this transition and develop recurrent DKA.
A group of authors recently published in Pharmacotherapy a retrospective cohort to evaluate the ability of serum bicarbonate levels of 16 mEq/L or less to predict intravenous to subcutaneous transition failures among those with a normal anion gap at the time of transition.
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.
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