The purpose of this process improvement project was to determine the appropriate potassium concentration of stocked IV fluids used in the treatment of diabetic ketoacidosis (DKA) at the Children's Hospital of The King's Daughters (CHKD) Emergency Department.
This is a retrospective chart review from July 1, 2018, through June 30, 2019. Patients ≤21 years of age with laboratory-confirmed DKA were included. The primary outcome was to determine the most used potassium concentration (20 mEq/L or 40 mEq/L) for stocked IV fluids. Secondary efficacy and safety outcomes included the percent of appropriately ordered fluids per the DKA treatment protocol, percent of patients who maintained goal serum potassium concentration, comparison of time from physician ordering to administration of prescribed IV fluids (t-elapsed), and comparison of serum potassium concentrations between the point of care (POC) test and basic metabolic panel (BMP).
Of the 113 patients included, 73 (64.6%) received 40 mEq/L, 7 of whom received half potassium acetate plus half potassium phosphate, and 40 (35.4%) received 20 mEq/L potassium IV fluids. In 101 patients (89.4%), fluids were ordered appropriately per protocol. Of these patients, 53 (52.5%) maintained goal serum potassium concentration. The t-elapsed from physician ordering to administration of the prescribed fluid concentrations was not statistically significant. The mean POC versus BMP potassium concentration was statistically significant (4.56 mmol/L versus 4.96 mmol/L, respectively; 95% CI: −0.49 to −0.30; p < 0.001).
The CHKD pharmacy should stock the most used 40 mEq/L potassium IV fluids for DKA treatment.