(1504) Early Fluid Resuscitation and Hospital Outcomes Among Adult Patients With Diabetic Ketoacidosis

Introduction: Early fluid resuscitation is a vital part of the management of diabetic ketoacidosis (DKA). Few studies have examined the effect of fluid timing during acute resuscitation on time to resolution of DKA and hospital outcomes. This study aims to assess the impact of early fluid administration on hospital outcomes among patients presenting with DKA.

Methods: Retrospective cohort study in a large community health care system (310,000 annual emergency visits) of all adults (age ≥ 18 years) admitted from January 2017 through December 2023 with an ICD-10 diagnosis of DKA and met all the biochemical parameters for the diagnosis of DKA as defined by the ADA and had the diagnosis made in the emergency department. Time zero was defined as the first contact with a healthcare provider and initiation time was defined as the first fluid bolus given time. Generalized linear models were used to assess the adjusted relationship between the time to fluid bolus initiation and hospital outcomes.

Results: 2187 patients met inclusion criteria, the median age was 41.3 years, 49.5% were female, and 41.4% were White. The median time to fluid initiation and resolution of DKA were 0.5 hours and 11.9 hours respectively, 6.6% required mechanical ventilation, and mortality was 8.3%. Baseline biochemical parameters are as follows: Glucose: 501.0 (394.0-560.0) mmol/l, K+: 5.1 (4.5-5.8) mmol/l, HCO3: 10.0 (6.0-14.0) mmol/l, pH: 7.2 (7.1-7.2), Anion Gap: 26.0 (21.0-30.0) mmol/l, HBA1C: 12.2% (10.4-14.0), Beta-hydroxybutyrate: 75.9 (47.4-103.2) mg/dl. For each hour of delay to fluid initiation, the time to resolution of DKA increases by 32 minutes (p-value = < 0.01), while hospital charges increase by $1,113 (p-value = < 0.01). We observed decreased odds of ventilation use when fluid bolus was initiated in the 1st hour [OR 0.53 (95% CI 0.35-0.80), p = < 0.01] and a corresponding increased odds when the fluid bolus was initiated after 2 hours [OR 2.29 (95%CI 1.13-4.63), p = 0.02]. There was no significant association between time to fluid initiation and mortality.

Conclusions: Our findings show that earlier fluid initiation is associated with reduced time to resolution of DKA, less requirement for mechanical ventilation, and lower hospital cost.