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Improving Care For Pediatric Diabetic Ketoacidosis

Abstract OBJECTIVE: We sought to create and implement recommendations from an evidence-based pathway for hospital management of pediatric diabetic ketoacidosis (DKA) and to sustain improvement. We hypothesized that development and utilization of standard work for inpatient care of DKA would lead to reduction in hypokalemia and improvement in outcome measures. METHODS: Development involved systematic review of published literature by a multidisciplinary team. Implementation included multidisciplinary feedback, hospital-wide education, daily team huddles, and development of computer decision support and electronic order sets. RESULTS: Pathway-based order sets forced clinical pathway adherence; yet, variations in care persisted, requiring ongoing iterative review and pathway tool adjustment. Quality improvement measures have identified barriers and informed subsequent adjustments to interventions. We compared 281 patients treated postimplementation with 172 treated preimplementation. Our most notable findings included the following: (1) monitoring of serum potassium concentrations identified unanticipated hypokalemia episodes, not recognized before standard work implementation, and ea Continue reading >>

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Popular Questions

  1. Punkin

    Hi, I've been pretty good at sticking to the plan for about two months but I want to start experimenting a bit more with my diet. I was wondering if people could just give me some examples of things that knock them out of ketosis. It doesn't matter what it is, I just need of rough idea of what kinds of things might do it.

  2. Knittering

    Too many carbs at once. That's pretty much it, since I don't eat bars, noodles, etc. with magic carb math.

  3. raindroproses

    Ugh, Atkins bars and shakes! Just one of them messed me up each time I had one and I was out of it for days. Other than that, yeah... too many carbs at once, or too many in a day in general. For me that amounts to usually not allowing more than 20 TOTAL per day. Normally my count is kept closer to 10. That means even if I have a little snack that has fruit in it, I'm running the risk of being kicked out of ketosis. Lousy, since I enjoy fruit. But I'm hoping once I'm in maintenance fruit will be able to be a "sometimes" moderate snack food

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