K. Hone, MSD. Agus, CM. Russ, S. Manzi, L. Berbert, S. Engstrand, et al. (2025). Comparison of 2-Bag Method With Serial Bag Method for Treatment of Pediatric Diabetic Ketoacidosis. Dimensions of critical care nursing : DCCN, 44(2), 85-90. https://doi.org/10.1097/DCC.0000000000000682

PubMed 39853727

[Abstract]
BACKGROUND: There have been 2 primary methods of intravenous fluid administration for diabetic ketoacidosis (DKA) treatment described in the literature: the serial bag method and the 2-bag method.

OBJECTIVES: This study will assess the clinical outcomes and workflow efficiency after a transition in practice from the serial fluid method to the 2-bag method for pediatric DKA.

METHODS: This was a retrospective chart review of pediatric DKA patients 18 years or younger, 1 year before and after the transition was conducted. After exclusion criteria, 94 patients in the serial bag method group and 100 patients in the 2-bag method group remained. Variables included patient demographics, laboratory values, and duration of therapy.

RESULTS: Patients achieving physiologic resolution of DKA had a median duration of 8.7 hours using the serial bag method and 7.5 hours using the 2-bag method (P = .193). Duration of DKA pharmacologic therapy had median values of 11.6 and 12.7 hours, between the serial bag and 2-bag method, respectively (P = .203). The 2-bag method resulted in faster workflow efficiency per bag for intravenous fluids, with a median duration of 35.5 minutes compared with 44.5 minutes using the serial bag (P = .025). Episodes of hypokalemia (P = .010) and hyperchloremia (P = .002) with the 2-bag method were significantly more frequent.

DISCUSSION: Duration of DKA pharmacologic therapy and that of physiologic DKA were not statistically different between methods. Workflow efficiency improved with the 2-bag method. Further studies are needed to address potential electrolyte disturbances with the 2-bag method.