Is the two-bag method viable for DKA treatment?

The two-bag method is both safe and effective for the management of diabetic ketoacidosis (DKA) relative to the one-bag method, a study has shown.

A total of 1,084 patients treated for DKA at a Trinity Health institution between 2020 and 2022 were included in this retrospective chart review. Those treated with the one-bag and two-bag methods were included in the pre-group and the post-group, respectively. Patients who were pregnant or had hyperosmolar hyperglycaemia state (HHS), euglycaemic DKA, or ketosis for other causes were excluded.

The incidence of hypoglycaemia (blood glucose <70 mg/dL) was the primary outcome, while time to anion gap closure, insulin infusion duration, time to HCO3 correction, and incidence of hypokalemia were secondary.

Hypoglycaemia occurred in 38 percent of patients in the pre-group and in 15.83 percent of those in the post-group (p<0.001).

Patients in the pre-group stayed longer on insulin infusion than those in the post-group (28.37 vs 22.17 hrs; p<0.001). Pre-group patients also had a slower time to anion gap closure (8.99 vs 8.52 hrs; p=0.021) and a slower time to HCO3 correction (10.88 vs 10.69 hrs; p=0.004).

In addition, the incidence of hypokalemia did not significantly differ between the two groups (66.39 percent vs 60 percent; p=0.079).