Improving Emergency Department Care for Children with Diabetic Ketoacidosis

Strategic Insights -

A new study published in the Pediatrics journal aimed to increase the use of a 2-bag intravenous fluid system for treating diabetic ketoacidosis (DKA) in children. The research, conducted at two tertiary care pediatric hospitals, found that a quality improvement initiative led to a significant increase in the use of 2-bag IV fluids, from 41.3% to 77.7%. The initiative involved developing a clinical practice guideline, education, and electronic medical record updates. The study spanned pre- and post-initiative periods, as well as a stability period, and included 876 eligible encounters.

Key Takeaways:

  • A quality improvement initiative increased the use of 2-bag IV fluids from 41.3% to 77.7% in children with medium- or high-risk DKA.
  • The initiative involved developing a clinical practice guideline, education, and electronic medical record updates.
  • The study spanned pre- and post-initiative periods, as well as a stability period, with a total of 876 eligible encounters.
  • A higher proportion of non-Hispanic Black children was observed in the stability period (26.3%) compared to the pre- (17.7%) and post-initiative (18.2%) periods.
  • The study did not observe changes in time to isotonic fluid bolus, continuous insulin, or 2-bag IV fluids, and there was no change in hypoglycemic events.
  • The research concluded that a combination of interventions, including implementation and refinement of a clinical guideline, creation of a nurse algorithm, and nursing education, improved emergency department care for children with medium- and high-risk DKA.

Statistics:

  • 41.3% of children with medium- or high-risk DKA received 2-bag IV fluids pre-initiative.
  • 26.3% of non-Hispanic Black children were observed in the stability period.
  • 18.2% of children with medium- or high-risk DKA received 2-bag IV fluids post-initiative.
  • 77.7% of children with medium- or high-risk DKA received 2-bag IV fluids post-initiative.
  • 876 eligible encounters were included in the study.
  • The study spanned pre- and post-initiative periods, as well as a stability period.

Sources:

  • NewsRx. Studies from Department of Endocrinology Provide New Data on Diabetic Ketoacidosis (Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis). Pediatrics Week. September 20, 2025; p 942.
  • Pediatrics. Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis. 2025.