Background The development of protocols for the treatment of pathologies that require close monitoring, such as diabetic ketoacidosis (DKA), and the simplification of their associated prescriptions in the Electronic Clinical History (ECH) can mean greater safety for patients.

Purpose To describe the development of a protocol for the management of DKA for patients attending the Emergency Room.

Material and methods A descriptive study of a protocol developed by the Emergency Pharmacy Specialist in agreement with the Endocrinology and Emergency Services and integrated into the ECH (Selene^®)

The most current DKA clinical practice guidelines were reviewed, to establish insulin and potassium therapy, the transition to subcutaneous insulin, rate of therapy administration and when to measure blood glucose and potassaemia.

Commercial dilute potassium solutions (concentration <40 mEq/L) were used following the recommendations of the Ministry of Health and Social Policy for the safe use of potassium IV, published in 2009, to maintain serum potassium levels within the normal range of 4–5 mEq/L.

Results The protocol was called Ketoacidosis and was integrated into the ECH program.

Two subsections were created: Fluid-potassium and Insulin therapy. As to the first, we established lines of prescription associated with different contributions of potassium, according to serum potassium (K⁺): (K⁺>5.5: SF 0.9%; K⁺(3.3–4.5):20 mEqCLK/500 mL SF 0.9%; K⁺(4.6–5.5):10 mEqCLK/500 mL SF 0.9%; K⁺<3.3:20 mEq/500 mL SF 0.9% each hour.

Each prescribing line had associated information on the rate of administration based on the hours elapsed from the beginning of the DKA treatment:1 st hour: 1,000 mL; 2nd–3rd hour: 500 mL/h; 4th–5th–6th–7th hour: 250 mL/h; then: 150 mL/h and notifications of the measurement of potassemia every 1–2 hours during the first 6 hours of DKA.

The Insulin therapy subsection included: prescription lines for initiation of IV insulin treatment in continuous perfusion (PC), subcutaneous (SC)insulin to be administered once DKA had been resolved and notifications to increase or decrease the rate of insulin PC according to blood glucose, administer glucose and decrease by half the insulin PC (glucose <250 mg/dL and ketonaemia >0.6 mmol/L), record the time of onset of basal insulin administration SC, suspend the insulin PC 1 hour after the administration of basal insulin SC and notify the doctor when blood glucose <250 mg/dL and ketonaemia <0.6 mmol/L.

Conclusion This protocol has facilitated prescriptions in HCE, has decreased associated errors in prescribing medication and has guaranteed safety in the administration of treatment.

References and/or Acknowledgements Joint British Diabetes Societies.

American Diabetes Association.

Spanish Society of Emergency Medicine Diabetes.

http://www.ismp-espana.org/documentos/view/54

No conflict of interest