Two-bag on par with one-bag system in adults with diabetic ketoacidosis

The efficacy and safety of the two-bag (TB) system are comparable to those of the one-bag (OB) system in adults with diabetic ketoacidosis (DKA), results of a study have shown. Both approaches can be considered in adult DKA patients.

The authors performed a retrospective review at an academic medical centre to determine if the TB system, which utilizes two intravenous (IV) fluid bags, one containing sodium chloride and the other containing sodium chloride and dextrose, is a safe and effective alternative to the tradition OB system.

Adults with DKA were included if they were treated with either the OB or the TB system. Time to anion gap closure was the primary outcome. Secondary ones were as follows: duration of insulin infusion, time to serum bicarbonate correction, number of continuous IV fluid orders, intensive care unit (ICU) and hospital length of stay (LOS), and rates of hypoglycaemia and hypokalaemia.

In total, 122 patients met the eligibility criteria. Of these, 68 were treated with the OB system and 54 with the TB system. No between-group differences were observed in time to anion gap closure, duration of insulin infusion, ICU LOS, or hospital LOS.

On the other hand, the OB group had shorter time to bicarbonate correction (13.5 hours, interquartile range [IQR], 7–29) than the TB group (25 hours, IQR, 11–50; p=0.03). No differences were seen in the rates of hypoglycaemia or hypokalaemia between the two groups.

“DKA is a serious complication of diabetes mellitus,” according to the authors.