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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When should determination of ketonemia be recommended? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The measured serum sodium concentration can be corrected for the changes related to hyperglycemia by adding 1.
Cerebral edema is associated with a mortality rate of up to 70 percent. Successful outpatient therapy requires the absence of severe intercurrent illness, an alert patient who is able to resume oral intake and the presence of mild diabetic ketoacidosis pH of greater than 7.
Patients with an increased alveolar to arterial oxygen gradient AaO2 and patients with pulmonary rales on physical examination may be at increased risk for ARDS. When patients are able to eat, multidose subcutaneous therapy with both regular short-acting and intermediate-acting insulin may be given. See My Options close Already a member or subscriber?
The use of bicarbonate is not recommended in most patients. This dreaded treatment complication occurs in approximately 1 percent of children with diabetic ketoacidosis.
ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis
This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level. Indications for hospitalization include greater than 5 percent loss of body weight, respiration rate of greater than 35 per minute, intractable elevation of blood glucose concentrations, change in mental status, uncontrolled fever and unresolved nausea and vomiting.
The beta-hydroxybutyrate level may not normalize during the first one to two days of treatment. Common problems that produce ketosis include alcoholism and starvation. Prompt involvement of a critical care specialist is prudent.
Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED
Insulin may be mixed in a standard concentration of 1 U per folwsheet mL of normal saline. Cessation of insulin infusion at night-time during CSII-therapy: Read the full article. Blood glucose levels are monitored every four hours, and regular insulin is given subcutaneously every four hours using a sliding scale Figure 2.
In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy. We hope that you will find these materials to be helpful in managing pediatric cases of diabetic ketoacidosis.
The management of diabetic emergencies. Information For Patients Patients need to be educated on the risks of avoiding their insulin in order to prevent re-admission with DKA.
Onset of headache or mental status changes during therapy should lead to consideration of this complication.
Insulin therapy should be continued until ketones are reduced to an flowsueet level.
dk Even in comatose patients, information documenting a history of diabetes or insulin therapy may be available. Cerebral oedema during treatment of diabetic ketoacidosis: The goal is to maintain the serum potassium concentration in the range of 4 to 5 mEq per L 4 to 5 mmol per L. Osmotic diuresis leads to increased urinary phosphate losses.
Lispro and aspart NovoLog insulin are more expensive and do not work faster than regular insulin when given intravenously.
Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. Intravenous mannitol in a dosage of 1 to 2 g per kg given over 15 minutes is the mainstay of therapy.
Management of Diabetic Ketoacidosis
Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. As noted previously, however, overly rapid rehydration or overcorrection of hyperglycemia appears to increase the risk of cerebral edema. If the patient has significant hypertriglyceridemia, it can falsely lower glucose and sodium measurements by dilution.
Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. This allows continued insulin administration until ketonemia is controlled and also helps to avoid iatrogenic hypoglycemia.
Diabetic Ketoacidosis – – American Family Physician
A irway, breathing, circulation C ommence fluid resuscitation T reat potassium Flowdheet eplace insulin A cidosis management P revent complications I nformation for patients D ischarge Fowsheet, Breathing, Circulation As Per Any Emergency DKA patients need to have their airway, breathing and circulation assessed immediately. Insulin is absorbed more rapidly intramuscularly than if given subcutaneously. Although the bicarbonate level typically is low, it may be normal or high in patients with vomiting, diuretic use, or alkali ingestion.
He is also associate professor of medicine at the University of Tennessee, Memphis, College of Medicine, where he attended medical school and completed residency training. Electrolytes with calculated anion gap and effective osmolality. This content is owned by the AAFP. Strength of Recommendations Key clinical recommendation Label References Comments Regular insulin by continuous intravenous infusion is preferred for moderate to severe diabetic ketoacidosis.
Mechanism of normochloremic and hyperchloremic acidosis in diabetic ketoacidosis.