Examining the “Killer K” of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study
Abstract Objectives Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identi...
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| Veröffentlicht in: | Canadian journal of diabetes 2016-06, Vol.40 (3), p.204-209 |
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| container_title | Canadian journal of diabetes |
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| creator | Wong, Bertha, MD Cheng, Amy, MD, MBA, FRCPC Yu, Catherine, MD, MHSc, FRCPC Goguen, Jeannette, MD, MEd, FRCPC |
| description | Abstract Objectives Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care. Methods We conducted a retrospective chart review to establish the prevalence of hypokalemia in patients diagnosed with DKA between July 2012 and July 2013. A focused root-cause analysis was subsequently performed to identify Canadian Diabetes Association DKA clinical practice guideline deviations and preventable errors that resulted in significant hypokalemia (K |
| doi_str_mv | 10.1016/j.jcjd.2015.10.002 |
| format | Article |
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We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care. Methods We conducted a retrospective chart review to establish the prevalence of hypokalemia in patients diagnosed with DKA between July 2012 and July 2013. A focused root-cause analysis was subsequently performed to identify Canadian Diabetes Association DKA clinical practice guideline deviations and preventable errors that resulted in significant hypokalemia (K<3.3 mmol/L) during the first 48 hours of management. Clinical and management details were reviewed to determine the type, preventability and root cause(s) of each error. Results We identified 40 cases of DKA during the study period. The overall prevalence of hypokalemia during DKA treatment was 38% (15/40), with 25% in type 1 and 56% in type 2 diabetes. Males were more likely to experience hypokalemia (87%), and 47% of hypokalemic incidents occurred in the first presentation of diabetes. All 10 cases of significant hypokalemia were reviewed. We identified 23 errors in 6 (60%) cases, of which 87% were deemed to be preventable. The most common errors were noncessation of insulin infusion during hypokalemia (60%), inadequate potassium supplementation (50%) and infrequent biochemical monitoring (50%). Conclusions Hypokalemia occurs frequently during acute DKA management and is often preventable. Our findings suggest that interventions targeted at enhancing awareness of guidelines may reduce hypokalemia rates.</description><identifier>ISSN: 1499-2671</identifier><identifier>EISSN: 2352-3840</identifier><identifier>DOI: 10.1016/j.jcjd.2015.10.002</identifier><identifier>PMID: 26970890</identifier><language>eng</language><publisher>Canada: Elsevier Inc</publisher><subject>acidocétose diabétique ; amélioration de la qualité ; diabetic ketoacidosis ; Diabetic Ketoacidosis - complications ; Diabetic Ketoacidosis - drug therapy ; Endocrinology & Metabolism ; Female ; Humans ; hyperglycemic emergency ; hypokalemia ; Hypokalemia - diagnosis ; Hypokalemia - drug therapy ; Hypokalemia - epidemiology ; hypokaliémie ; Insulin - adverse effects ; Insulin - therapeutic use ; Male ; Medical Errors ; Other ; patient safety ; Potassium - administration & dosage ; Potassium - therapeutic use ; Prevalence ; quality improvement ; Retrospective Studies ; sécurité du patient ; Tertiary Care Centers ; urgence hyperglycémique</subject><ispartof>Canadian journal of diabetes, 2016-06, Vol.40 (3), p.204-209</ispartof><rights>Canadian Diabetes Association</rights><rights>2015 Canadian Diabetes Association</rights><rights>Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-11ce730c3350898385b6246c34adff54e5638649228514ff50f7a86c435cc0293</citedby><cites>FETCH-LOGICAL-c411t-11ce730c3350898385b6246c34adff54e5638649228514ff50f7a86c435cc0293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26970890$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Bertha, MD</creatorcontrib><creatorcontrib>Cheng, Amy, MD, MBA, FRCPC</creatorcontrib><creatorcontrib>Yu, Catherine, MD, MHSc, FRCPC</creatorcontrib><creatorcontrib>Goguen, Jeannette, MD, MEd, FRCPC</creatorcontrib><title>Examining the “Killer K” of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study</title><title>Canadian journal of diabetes</title><addtitle>Can J Diabetes</addtitle><description>Abstract Objectives Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care. Methods We conducted a retrospective chart review to establish the prevalence of hypokalemia in patients diagnosed with DKA between July 2012 and July 2013. A focused root-cause analysis was subsequently performed to identify Canadian Diabetes Association DKA clinical practice guideline deviations and preventable errors that resulted in significant hypokalemia (K<3.3 mmol/L) during the first 48 hours of management. Clinical and management details were reviewed to determine the type, preventability and root cause(s) of each error. Results We identified 40 cases of DKA during the study period. The overall prevalence of hypokalemia during DKA treatment was 38% (15/40), with 25% in type 1 and 56% in type 2 diabetes. Males were more likely to experience hypokalemia (87%), and 47% of hypokalemic incidents occurred in the first presentation of diabetes. All 10 cases of significant hypokalemia were reviewed. We identified 23 errors in 6 (60%) cases, of which 87% were deemed to be preventable. The most common errors were noncessation of insulin infusion during hypokalemia (60%), inadequate potassium supplementation (50%) and infrequent biochemical monitoring (50%). Conclusions Hypokalemia occurs frequently during acute DKA management and is often preventable. Our findings suggest that interventions targeted at enhancing awareness of guidelines may reduce hypokalemia rates.</description><subject>acidocétose diabétique</subject><subject>amélioration de la qualité</subject><subject>diabetic ketoacidosis</subject><subject>Diabetic Ketoacidosis - complications</subject><subject>Diabetic Ketoacidosis - drug therapy</subject><subject>Endocrinology & Metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>hyperglycemic emergency</subject><subject>hypokalemia</subject><subject>Hypokalemia - diagnosis</subject><subject>Hypokalemia - drug therapy</subject><subject>Hypokalemia - epidemiology</subject><subject>hypokaliémie</subject><subject>Insulin - adverse effects</subject><subject>Insulin - therapeutic use</subject><subject>Male</subject><subject>Medical Errors</subject><subject>Other</subject><subject>patient safety</subject><subject>Potassium - administration & dosage</subject><subject>Potassium - therapeutic use</subject><subject>Prevalence</subject><subject>quality improvement</subject><subject>Retrospective Studies</subject><subject>sécurité du patient</subject><subject>Tertiary Care Centers</subject><subject>urgence hyperglycémique</subject><issn>1499-2671</issn><issn>2352-3840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhS0EokPhBVggL9lk8G_iIIRUDQNFU4lFy9ryODfFwRMPtlN1dn0QeLk-CY6msGDBytLxOUf3fhehl5QsKaH1m2E52KFbMkJlEZaEsEdowbhkFVeCPEYLKtq2YnVDT9CzlAZCJGlo-xSdsLptiGrJAl2vb83OjW68xvkb4Pu7nxvnPUS8ub_7hUOPPzizhews3kAOxrouJJewydjgK4jZmXjAKxMBn4e0d9n4t_hsxOvbvQ_R5FB-L_PUHZ6jJ73xCV48vKfo68f11eq8uvjy6fPq7KKygtJcUWqh4cRyLst8iiu5rZmoLRem63spQNZc1aJlTEkqikL6xqjaCi6tJazlp-j1sXcfw48JUtY7lyx4b0YIU9K0aZnkjRKqWNnRamNIKUKv99Htyj6aEj0D1oOeAesZ8KwVwCX06qF_2u6g-xv5Q7QY3h0NULa8cRB1sg5GC52LYLPugvt___t_4taX81jjv8MB0hCmOBZ-murENNGX84nnC1NJSFPA8N8RbKEk</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Wong, Bertha, MD</creator><creator>Cheng, Amy, MD, MBA, FRCPC</creator><creator>Yu, Catherine, MD, MHSc, FRCPC</creator><creator>Goguen, Jeannette, MD, MEd, FRCPC</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160601</creationdate><title>Examining the “Killer K” of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study</title><author>Wong, Bertha, MD ; Cheng, Amy, MD, MBA, FRCPC ; Yu, Catherine, MD, MHSc, FRCPC ; Goguen, Jeannette, MD, MEd, FRCPC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-11ce730c3350898385b6246c34adff54e5638649228514ff50f7a86c435cc0293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>acidocétose diabétique</topic><topic>amélioration de la qualité</topic><topic>diabetic ketoacidosis</topic><topic>Diabetic Ketoacidosis - complications</topic><topic>Diabetic Ketoacidosis - drug therapy</topic><topic>Endocrinology & Metabolism</topic><topic>Female</topic><topic>Humans</topic><topic>hyperglycemic emergency</topic><topic>hypokalemia</topic><topic>Hypokalemia - diagnosis</topic><topic>Hypokalemia - drug therapy</topic><topic>Hypokalemia - epidemiology</topic><topic>hypokaliémie</topic><topic>Insulin - adverse effects</topic><topic>Insulin - therapeutic use</topic><topic>Male</topic><topic>Medical Errors</topic><topic>Other</topic><topic>patient safety</topic><topic>Potassium - administration & dosage</topic><topic>Potassium - therapeutic use</topic><topic>Prevalence</topic><topic>quality improvement</topic><topic>Retrospective Studies</topic><topic>sécurité du patient</topic><topic>Tertiary Care Centers</topic><topic>urgence hyperglycémique</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Bertha, MD</creatorcontrib><creatorcontrib>Cheng, Amy, MD, MBA, FRCPC</creatorcontrib><creatorcontrib>Yu, Catherine, MD, MHSc, FRCPC</creatorcontrib><creatorcontrib>Goguen, Jeannette, MD, MEd, FRCPC</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of diabetes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Bertha, MD</au><au>Cheng, Amy, MD, MBA, FRCPC</au><au>Yu, Catherine, MD, MHSc, FRCPC</au><au>Goguen, Jeannette, MD, MEd, FRCPC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Examining the “Killer K” of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study</atitle><jtitle>Canadian journal of diabetes</jtitle><addtitle>Can J Diabetes</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>40</volume><issue>3</issue><spage>204</spage><epage>209</epage><pages>204-209</pages><issn>1499-2671</issn><eissn>2352-3840</eissn><abstract>Abstract Objectives Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care. Methods We conducted a retrospective chart review to establish the prevalence of hypokalemia in patients diagnosed with DKA between July 2012 and July 2013. A focused root-cause analysis was subsequently performed to identify Canadian Diabetes Association DKA clinical practice guideline deviations and preventable errors that resulted in significant hypokalemia (K<3.3 mmol/L) during the first 48 hours of management. Clinical and management details were reviewed to determine the type, preventability and root cause(s) of each error. Results We identified 40 cases of DKA during the study period. The overall prevalence of hypokalemia during DKA treatment was 38% (15/40), with 25% in type 1 and 56% in type 2 diabetes. Males were more likely to experience hypokalemia (87%), and 47% of hypokalemic incidents occurred in the first presentation of diabetes. All 10 cases of significant hypokalemia were reviewed. We identified 23 errors in 6 (60%) cases, of which 87% were deemed to be preventable. The most common errors were noncessation of insulin infusion during hypokalemia (60%), inadequate potassium supplementation (50%) and infrequent biochemical monitoring (50%). Conclusions Hypokalemia occurs frequently during acute DKA management and is often preventable. Our findings suggest that interventions targeted at enhancing awareness of guidelines may reduce hypokalemia rates.</abstract><cop>Canada</cop><pub>Elsevier Inc</pub><pmid>26970890</pmid><doi>10.1016/j.jcjd.2015.10.002</doi><tpages>6</tpages></addata></record> |
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| subjects | acidocétose diabétique amélioration de la qualité diabetic ketoacidosis Diabetic Ketoacidosis - complications Diabetic Ketoacidosis - drug therapy Endocrinology & Metabolism Female Humans hyperglycemic emergency hypokalemia Hypokalemia - diagnosis Hypokalemia - drug therapy Hypokalemia - epidemiology hypokaliémie Insulin - adverse effects Insulin - therapeutic use Male Medical Errors Other patient safety Potassium - administration & dosage Potassium - therapeutic use Prevalence quality improvement Retrospective Studies sécurité du patient Tertiary Care Centers urgence hyperglycémique |
| title | Examining the “Killer K” of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study |
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