Safety and Efficacy of an Algorithm-Based Protocol in the Management of Diabetic Ketoacidosis

Objective: To determine the efficacy of an algorithm-based protocol to manage diabetic ketoacidosis (DKA). Methods: Our study is a retrospective chart review of patients with DKA managed before and after implementation of an algorithm-based DKA protocol at a tertiary care hospital. Results: There were 88 patients managed 1 year prior (control group) and 70 patients managed one year after (study group) implementation of the algorithm-based DKA protocol. The DKA resolution time was significantly shorter (11.5 [8.1 to 17.1] hours versus 8.5 [5.8 to 12] hours; P = 0.008) and the hypoglycemic events were significantly less ( P = 0.042) in the study group in comparison with the control group. There was no difference in the potassium abnormalities and rate of decline of glucose. A survey on a scale of 1 to 10 found the majority of physicians and nurses rated the protocol as safe (83%) and effective (96%). Fifty-four percent of the nurses, however, found the protocol difficult to follow. Conclusion: Our study showed that implementation of an algorithm-based protocol reduced the DKA resolution time and hypoglycemic events without compromising electrolyte imbalance, and was associated with improved clinical measures of DKA management.