ABC, VS, level of dehydration; Mental status, neuro exam, GCS; Risk for cerebral edema; CR monitor, VS q 15 min, I/O q 1 hr; Start DKA Flow Sheet. IV Access. Diabetic ketoacidosis (DKA) though preventable remains a frequent and life written and accompanied by a practical and easy to follow flow chart to be used in. Diabetic. Ketoacidosis. DKA. Resource Folder. May by Eva Elisabeth Oakes, RN, and Dr. Louise Cole, Senior Staff Specialist.

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Therefore, the use of bicarbonate in a patient with a pH greater than 7. The severity of fluid and sodium deficits Table 1 4 is determined primarily by the duration of hyperglycemia, the level of renal function and the patient’s fluid intake. Infection, particularly pneumonia, urinary tract infection, and sepsis 4 Inadequate insulin treatment or noncompliance 4 New-onset diabetes 4 Cardiovascular disease, particularly myocardial infarction 5.

Bicarbonate therapy in severe diabetic ketoacidosis. Intravenous insulin should continue for one to two hours after initiation of subcutaneous insulin. The replacement of insulin is the cornerstone of rectifying DKA as it allows the uptake of glucose as an energy source, thereby reducing hyperglycaemia and stopping the pathophysiology of gluconeogenesis.

ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis

Case Studies in International Travelers. Although intravenous insulin infusion can be changed quickly and studies have found more rapid initial improvement in glucose and bicarbonate levels, there is no improvement in morbidity and mortality over insulin administered intramuscularly or subcutaneously.

Although the phosphate level frequently is low in patients with DKA, good-quality studies have shown that routine phosphate replacement does not improve outcomes in DKA, and excessive replacement can lead flowshee hypocalcemia.

In more severe cases, seizures, pupillary changes, and respiratory arrest with brain-stem herniation may occur. The most common precipitating factor is infection, followed by noncompliance with insulin therapy. TABLE 4 Strategies to Prevent Diabetic Ketoacidosis Diabetic education Blood glucose monitoring Sick-day management Home monitoring of ketones or beta-hydroxybutyrate Supplemental short-acting insulin regimens Easily digestible liquid diets when sick Reducing, rather than eliminating, insulin when patients are not eating Guidelines for when patients should seek medical attention Case monitoring of high-risk patients Special education for patients on pump management Information from references 49 through Initial presentation of diabetes mellitus.

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Choose a single article, issue, or full-access subscription. Another important aspect of rehydration therapy in patients with diabetic ketoacidosis is the replacement of ongoing urinary losses.

Guest editors of the series are Bruce Zimmerman, M. At this time, potassium flowhseet is added to intravenous fluids in the amount of 20 to 40 mEq per L. Selected patients with mild DKA who are alert and taking fluids orally may be treated under observation and sent home without admission.

Diabetic Ketoacidosis – – American Family Physician

Characteristics of diabetic ketoacidosis in older versus younger adults. Complications can include dehydration, hypovolaemia, hypotensionelectrolyte abnormalities, cardiac arrhythmias, cardiac arrest and cerebral oedema.

Avoiding overhydration and limiting the rate at which the blood glucose level drops may reduce the chance of cerebral edema. Continuous dkz of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes.

Fulminant diabetes mellitus associated with pregnancy: The conditions that cause these metabolic abnormalities overlap. Older patients are less likely to be on insulin before developing DKA, less likely to have had a previous episode of DKA, typically require more insulin to treat the DKA, have a longer length of hospital stay, and have a higher mortality rate 22 percent for those 65 years and older versus 2 percent for those younger than 65 years.

The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Admission to a step-down or intensive care unit should be considered for patients with hypotension or oliguria refractory to initial rehydration and for patients with mental obtundation or coma with hyperosmolality total osmolality of greater than mOsm per kg of water. Symptomatic cerebral edema occurs primarily in pediatric patients, particularly those with newly diagnosed diabetes.


A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Urinary losses then lead to progressive dehydration and volume depletion, which causes diminished urine flow and greater retention of glucose in plasma. C-peptide levels may be helpful for determining the type of diabetes and guiding subsequent treatment.

Alteration in sensoria or mental obtundation. Continuous subcutaneous insulin infusion at 25 years: Easily digestible liquid diets when sick.

DKA Protocol Page printed: Acidosis Management Acidosis is only actively managed by administering bicarbonate if the pH is less than 7. Hyperchloremia is a common but transient finding that usually requires no special treatment. The use of phosphate for this purpose reduces the chloride load that might contribute to hyperchloremic acidosis and decreases the likelihood that the patient will develop severe hypophosphatemia during insulin therapy.

A high serum sodium level almost always indicates hypernatremic dehydration. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Severely uncontrolled diabetes in the over-fifties. The amount of fluid resuscitation required in severe DKA is often the amount of fluid that is lost around six to ten litres. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes formerly called insulin-dependent diabetes mellitus ; however, its occurrence in patients with type 2 diabetes formerly called non—insulin-dependent diabetes mellitusparticularly obese black patients, is not as rare as was once thought.

Electrolytes with calculated anion gap and effective osmolality.

This content is owned by the AAFP. Endocrinol Metab Clin North Am. Normal or elevated Checking magnesium levels and correcting low levels should be considered in patients with DKA.

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