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Assessment of medication therapy for patients presenting to a community hospital emergency department with diabetic ketoacidosis or hyperglycemic hyperosmolar state
Thursday April 24, 2025 4:00pm - 4:15pm EDT
Athena I
Title: Assessment of medication therapy for patients presenting to a community hospital emergency department with diabetic ketoacidosis or hyperglycemic hyperosmolar state 
 
Authors: Madyson Cruse, Jason Dover, Adrianna T. Reagan, Margaret Williamson, Melissa Bagwell 
 
Learning Objective: Identify areas of improvement in the treatment of patients presenting with diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome 
 
Purpose: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially life-threatening metabolic conditions that require emergent treatment. As a mainstay of therapy, early fluid resuscitation helps restore intravascular volume deficits, end organ perfusion, and insulin sensitivity. The objective of this study was to assess the overall percentage of patients presenting with DKA or HHS who received an appropriate fluid bolus of 1 to 1.5 L within 2 hours of presentation to the emergency department. 
 
Methods: This is a single center, retrospective chart review of patients treated at East Alabama Health emergency department from October 2023 to April 2024. Patients were included if they were ordered an insulin infusion, had a documented admitting diagnosis of DKA or HHS from the emergency department, and were greater than 18 years of age. Outcome variables collected include patient demographics, baseline labs, time to fluid bolus, fluids administered, time to insulin administration, and if an insulin bolus and/or sodium bicarbonate were administered. Statistical tests, run on SPSS, include descriptive statistics, chi-square for categorical variables, and Kolmogorov-Smirnov to determine if data were normally distributed. 
 
Results: One hundred patients with DKA or HHS were reviewed for this study. For the primary outcome, 82 patients (82%) received an appropriate fluid bolus within 2 hours of presentation to the emergency department. The median time from presentation to administration of a fluid bolus was found to be 51 minutes [IQR: 23-95 minutes] with a median of 1 L bolus administered [IQR: 1-2 L]. Forty-two patients (42%) received an insulin bolus via either subcutaneous (2%) or intravenous (40%) routes, and 16 patients (16%) were administered insulin prior to initial laboratory results. Arterial blood gases, collected on 90 patients (90%), revealed that 6 patients (6.7%) met criteria for classi
Moderators
avatar for Hania Zaki

Hania Zaki

Pediatric Cardiac Pharmacy Specialist, CHGA1Children's Healthcare AtlantaPGY1
Presenters
avatar for Madyson Cruse

Madyson Cruse

PGY2 Emergency Medicine Pharmacy Resident, East Alabama Medical Center
Madyson is originally from Franklin, North Carolina. She pursued her pharmacy prerequisite courses at Western Carolina University in Cullowhee, North Carolina before completing her PharmD at East Tennessee State University Bill Gatton College of Pharmacy in Johnson City, Tennessee... Read More →
Evaluators
avatar for Erin Massarello
Thursday April 24, 2025 4:00pm - 4:15pm EDT
Athena I
  Critical Care/Emergency Medicine (CCM), East Alabama Medical Center
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