Bohach, Nathan PharmD, BCPS1; Moorman, John M. PharmD, BCPS2; Cunningham, Brittany PharmD, BCPS, BCCCP1; Mullen, Chanda PhD1,*; Fowler, Melissa PharmD, BCPS, BCCCP1
1Department of Pharmacy, Cleveland Clinic Akron General; and
2Department of Pharmacy Practice, Northeast Ohio Medical University.
*Address for correspondence: Melissa Fowler, PharmD, BCPS, BCCCP, Department of Pharmacy, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307. E-mail: [email protected]
This was a single-center, retrospective cohort study of patients who presented with DKA between January 1, 2018 and December 31, 2018. Each patient encounter was reviewed individually for those who presented with DKA multiple times during the study period. This study was approved by the Institutional Review Board, and the requirement for informed consent was waived. Authors have no conflicts of interest to declare. The study site contains 532 total beds including 5 ICUs. Patient encounters were identified for screening if the patient was 18 years of age or older, if they had a fingerstick or serum glucose ≥250 mg/dL, a serum bicarbonate <18 mmol/L, and received IV insulin. Patient encounters were included if they had positive ketones (urine or serum), an anion gap ≥12 mEq/L, and were admitted to a critical care area. Patient encounters were excluded if they received subcutaneous insulin before resolution of DKA, developed DKA during hospitalization but did not meet study criteria upon hospital presentation, were given an initial weight-based IV insulin infusion <0.07 units/kg/hour with no bolus, were transferred from another facility, had an IV insulin infusion lasting less than 8 hours, died before DKA resolution, or were pregnant.