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A novel protocol for the management of diabetic ketoacidosis in COVID-19-infected patients
Critical Care Medicine ; 49(1 SUPPL 1):49, 2021.
Article in English | EMBASE | ID: covidwho-1193816
ABSTRACT

INTRODUCTION:

In early March 2020, COVID-19 spread in New York City. This paper shows trends of rising cases of DKA associated with a worsening COVID-19 pandemic in New York City. With the potential for such a large number of DKA patients, our institution found a need for revised glycemic management protocol. We discuss how a multidisciplinary team designed a protocol to care for patients with COVID-19 infection and DKA.

METHODS:

Five of The Mount Sinai Health System's EDs are on a shared electronic health record system (Epic Systems, Verona, WI). Deidentified visit data extracted for routine quality review was made available for analysis. We looked at total visits and select visit diagnoses related to DKA through March, April and May 2019 and compared those counts to the same period in 2020. Our protocol was developed by stakeholders in a multidisciplinary hospital team. We focused on the basic tenets of DKA management insulin therapy, fluid resuscitation, and electrolyte repletion.

RESULTS:

A total of 93,218 visits were recorded across the five EDs from March 1-May 31, 2019. During that period there were 106 diagnoses of DKA made in the EDs (0.114% of visits). Across the same period in 2020 there were 59,009 visits, and 214 diagnoses of DKA (0.363% of visits). This coincides with the height of the Sars-CoV-2 pandemic in New York City. To address this surge, our protocol decreased the frequency of fingerstick monitoring, with changes to insulin dosing allowing admission to non-ICU beds. We transitioned from a provider-driven protocol to a nurse-driven protocol to avoid treatment delays due to order placement. Insulin infusion rate charts were created to provide nurses guidance on dosing modifications. To minimize ARDS risk, our protocol's fluid replacement recommendations lowered resuscitation and replacement rate volumes, adjusting based on provider reassessment. Lab values were monitored every 3-4 hours.

CONCLUSIONS:

There is a correlation between the rise of the Sars-CoV-2 pandemic in New York City and a net rise in patients diagnosed with diabetic ketoacidosis. We believe our DKA protocol will facilitate safe and effective management of patients with COVID-19 and DKA, reducing the healthcare burden associated with protocols that necessitate frequent treatment modifications and ICU-level care.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Critical Care Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Critical Care Medicine Year: 2021 Document Type: Article