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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Commence Fluid Resuscitation Due to the osmotic diuresis causing a large fluid depletion, fluid resuscitation is a must! Urinary output will decrease as the osmotic diuretic effect of hyperglycemia is reduced. Fulminant diabetes mellitus associated with pregnancy: Adult respiratory distress syndrome ARDS fliwsheet a rare but potentially fatal complication of the treatment of diabetic ketoacidosis.
Information For Patients Patients need to be educated on the risks of avoiding their insulin in order to prevent re-admission with DKA. Although the typical potassium deficit in diabetic ketoacidosis is to mEq to mmolmost patients are hyperkalemic at the time of diagnosis because of the effects of insulinopenia, hyperosmolality and acidemia. Initial presentation of diabetes mellitus. Although DKA is less common in these patients than among those with type 1 diabetes, it flowaheet occur.
The replacement of insulin is the cornerstone of rectifying DKA flowshet it allows the uptake of glucose as an energy source, thereby reducing hyperglycaemia and stopping the pathophysiology of gluconeogenesis. The main differences in the management of children and adolescents compared with adults are the greater care in administering electrolytes, fluids, and insulin based on the weight of the patient and increased concern about high fluid rates inducing cerebral edema.
Hospital admission guidelines for diabetes. If the serum potassium is greater than 3. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the s. TABLE 3 Standard Laboratory Assessment for Patients with Diabetic Ketoacidosis Plasma glucose Electrolytes with calculated anion gap and effective osmolality Phosphorous Blood urea nitrogen and creatinine Beta-hydroxybutyrate or serum ketones if not available Complete urinalysis with urine ketones by dipstick Arterial blood gas or venous pH level if not available Complete blood count with differential Electrocardiography As indicated Bacterial cultures of urine, blood, throat, or other sites of suspected infection Chest radiography if pneumonia flwosheet cardiopulmonary disease is suspected Magnesium if patient has signs of hypomagnesemia such as cardiac arrhythmias, is alcoholic, or is taking diuretics A1C level may help determine whether this is an acute episode in a patient with well-controlled, undiagnosed, or poorly controlled diabetes.
The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. Furthermore, severe electrolyte derangements significantly increase the risk of life threatening cardiac arrhythmias.
Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level. Prompt involvement of a critical care specialist is prudent. Subsequently, regular insulin should dkz given in a dosage of 0. Furthermore, bicarbonate therapy carries some risks, including hypokalemia flwsheet overly rapid administration, paradoxic cerebrospinal fluid acidosis and hypoxia. The conditions that cause these metabolic abnormalities overlap.
If an intravenous rlowsheet pump is not available, insulin can be given intramuscularly. Diabetic ketoacidosis is a triad of hyperglycemia, ketonemia and acidemia, each of which may be caused by other conditions Figure 1. A combined metabolic-nephrologic approach to therapy.
Prospective studies have indicated no clinical benefit for phosphate replacement in the treatment of diabetic ketoacidosis, and excessive phosphate replacement may contribute to hypocalcemia and soft tissue metastatic calcification.
Diabetes Res Clin Pract. Therefore, they have fewer ketones available for the regeneration of bicarbonate during insulin administration.
This version auto-calculates dlowsheet fluid rates and has some pop-up screens to guide in the clinical evaluation of children presenting with DKA. If the blood glucose concentration does not fall by 50 to 70 mg per dL 2.
Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED
Patients usually are symptomatic at serum levels of dla. Although usually straightforward, the diagnosis of diabetic ketoacidosis is occasionally missed in unusual situations, such as when it is the initial vka of diabetes in infants or elderly patients or when patients present with sepsis or infarction of the brain, bowel or myocardium. Selected patients with mild DKA who are alert and taking fluids orally may be treated under observation and sent home without admission.
Sodium bicarbonate therapy in severe diabetic ketoacidosis. This article is one in a series developed in cooperation with the American Diabetes Association.
Management of Diabetic Ketoacidosis
Education to prevent recurrence should be offered to all patients, including how to manage sick days and when to call a physician. Diary from a Week in Practice. More in Pubmed Citation Related Articles. When the blood glucose level has dropped below mg per dL, the patient may be given fluid with 5 percent dextrose, such as 0. Management of Diabetic Ketoacidosis.
Diabetic Ketoacidosis – – American Family Physician
Check beta-hydroxybutyrate rather than ketones to evaluate the degree of ketosis. S95, with additional information from reference Education about diabetes is a cornerstone of prevention that also has been found to reduce length of stay.
He is also associate professor of medicine at the Dkq of Tennessee, Memphis, College of Medicine, where he attended medical school and completed residency training. Want to use this article elsewhere?
In the rare patient who presents with hypokalemia, insulin therapy may worsen the hypokalemia and precipitate life-threatening cardiac arrhythmias. Half of the fluid resuscitation volume is initially replaced quickly over the first eight hours, with the rest being administered over the next sixteen hours. Treatment of suspected cerebral edema should not be delayed for these tests to be vlowsheet. Blood glucose should be evaluated every one to two hours until the patient is stable, and the blood urea nitrogen, serum creatinine, sodium, potassium, and bicarbonate levels should be monitored every two to six hours depending on the severity of Kda.
Cerebral edema is associated with a mortality rate of up to 70 percent. Abdominal dlowsheet may be a symptom of ketoacidosis or part of the inciting cause of DKA, such as appendicitis or cholecystitis. About 10 percent of the patients initially diagnosed with cerebral edema have other intracranial pathology such as subarachnoid hemorrhage. The osmotic diuresis can cause a significant loss of fluid, leading to severe dehydration fkowsheet circulatory collapse.
Major components of the pathogenesis of diabetic ketoacidosis are reductions in effective concentrations of circulating insulin and concomitant elevations of counterregulatory hormones catecholamines, glucagon, growth hormone and cortisol.