New protocol improves diabetic acidosis management in ED

Insulin pumps may be restarted under the guidance of the certified diabetes educator. Electrolytes and glucose should be reassessed 2 hours after the insulin drip is stopped to ensure there is no return of the DKA.

Any patients with pH below 7.3, bicarbonate below 21 mEq/L, or an inability to tolerate oral intake will remain in the ED for continued observation and management. The patient is ready for discharge once pH is greater than 7.3, the anion gap closes, glucose reaches 250 mg/dL, and the patient can tolerate oral intake and has transitioned to subcutaneous insulin.

Following discharge, someone on the team should phone the patient, ideally within 24 hours, to ensure compliance with the postdischarge plan and schedule a follow-up clinic visit.

Ms. Koen reported having no disclosures.