Chapter 6: Inpatient Critical Care—Diabetic Ketoacidosis

CHAPTER AIMS

KEY WORDS

INTRODUCTION

Pharmacy practice in critical care environments provides many opportunities for managing a variety of acute disease states and is a place where pharmacists can play an impactful role in treatment plan development and treatment safety and efficacy monitoring. Critical care pharmacists are deemed essential members of the multiprofessional critical care team and multiorganizational recommendations have been made regarding foundational responsibilities of a critical care pharmacist.¹ Responsibilities include assisting in discussions with patients and/or family members to help make informed decisions regarding pharmacotherapy options, collaborating with the healthcare team to prevent potentially inappropriate drug therapy, and providing clinical consultation for pharmacotherapeutic issues related to critical illness. Additional responsibilities include providing reviews of the medication history to determine which maintenance medications should be continued during the acute illness; providing medication reconciliation for ICU patients at the time of ICU admission, upon transfer from the ICU to the ward, or upon discharge to home or another facility; and educating patients and/or caregivers regarding medications used to treat patients during and after acute illness. A valuable element of the care that the critical care pharmacist provides is using the medical record as one means to communicate with other healthcare professionals, and/or to document specific pharmacotherapeutic recommendations or activities.¹

In this chapter, the care provided for a fictitious patient with diabetic ketoacidosis (DKA) by a pharmacist applying critical thinking and clinical reasoning during the Pharmacists’ Patient Care Process (PPCP) will be described. DKA is considered a hyperglycemic, endocrine emergency and is the most serious and life-threatening acute complication of diabetes.^2,3 Patients can present severely ill with hemodynamic instability due to severe dehydration, electrolyte abnormalities, acidosis, nausea, vomiting, and significantly altered mental status. The mortality rate can be over 7%. Rapid diagnosis and treatment are key to minimizing poor outcomes. Pharmacist involvement in the management of DKA has been shown to decrease the incidence of hypoglycemia and helps with protocol interpretation and compliance.⁴

MY PRACTICE—A MEDICAL/SURGICAL INTENSIVE CARE UNIT AT A COMMUNITY-BASED TEACHING HOSPITAL

My practice site is in intensive care units ...