(257) Evaluation of One-Bag Versus Two-Bag System for Treatment of Diabetic Ketoacidosis in Adults

Introduction: Traditionally, a one-bag system for diabetic ketoacidosis (DKA) treatment has been utilized in the adult patient population. The one-bag system can be defined as a non-dextrose containing crystalloid fluid running at a fixed rate in combination with an insulin infusion. Once serum glucose meets a certain threshold, dextrose containing fluids are started. However, in the adult patient population, there is growing literature that demonstrates a two-bag system (non-dextrose containing and dextrose containing crystalloid) is associated with earlier correction of acidosis, shorter duration of IV insulin infusion, fewer IV bags used, and reduction in hypoglycemia occurrence.

Methods: This was a single center, retrospective cohort study at a 1500 bed quaternary care, academic medical center comparing patients with DKA who were treated with the one-bag versus two-bag system. The primary outcome was time to DKA resolution after presentation when using the two-bag method versus a one-bag method. The secondary outcomes were the incidence of hypoglycemia (serum or point of care glucose < 70 mg/dL) and severe hypoglycemia (defined as a serum or point of care glucose < 40 mg/dL), hypokalemia (K < 3.3 mEq/L), and incidence of a continuous dextrose containing fluid being initiated once a serum or point of care glucose met a defined threshold in the two-bag system versus the one-bag system.

Results: Ninety patients met the criteria for inclusion, 56 in the one-bag cohort and 34 in the two-bag cohort. There were no significant differences found for time to anion gap closure between the one-bag and two-bag groups (9.7 [IQR. 5.8-14.8] hours vs 10.7 [IQR 8.6-17.3] hours; p=0.20). The vast majority of patients in both groups did not experience hypoglycemic or hypokalemic events in the study period. When blood glucose dropped below the protocol specific threshold, a significantly larger proportion of patients in the two-bag group received dextrose compared to those in the one-bag group (20 [90%] vs 29 [60%]; p< 0.001).

Conclusions: Both systems have similar efficacy and safety outcomes and are appropriate to use in the treatment of DKA in adults.