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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Adult respiratory distress syndrome complicating severely uncontrolled diabetes mellitus: Hospital admission guidelines for diabetes.

A priority of treatment should be to protect and maintain the airway, particularly in the obtunded patient, and to treat shock if present.

Management of Diabetic Ketoacidosis

When should determination of ketonemia be recommended? Serum sodium is falsely lowered by 1.

Patients with known diabetes can typically be given the dosage they were receiving before the onset of diabetic ketoacidosis. A case of diabetic non-ketotic hyperosmolar coma with an increase with plasma 3-hydroxybutyrate. A combined metabolic-nephrologic approach to therapy. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued.

We also welcome any suggestions to make this flowshfet more useful to your practice. B 25 Beta-hydroxybutyrate is the main metabolic product in ketoacidosis.

Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels.

Education to prevent recurrence should be offered to all patients, including how to manage sick days and when to call a physician. Prompt involvement of a critical care specialist is prudent. 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.


Insulin may be mixed in a standard concentration of 1 U per 10 mL of normal saline.

DKA Protocol

Am J Med Sci. Normal or elevated To understand the symptoms of DKA and therefore how to manage it effectively, it is important to understand the pathophysiology of hyperglycaemia which is explained in the flowchart below: 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.

This acidosis has no adverse clinical effects and is gradually corrected over the subsequent 24 to 48 hours by enhanced renal acid excretion. Characteristics of diabetic ketoacidosis in older versus younger adults. Arch Intern Med ; Retrospective reviews and prospective randomized studies have failed to identify changes in morbidity or mortality with sodium bicarbonate therapy in patients who presented with a pH of 6.

Management of Diabetic Ketoacidosis – – American Family Physician

Endocrinol Metab Clin North Am. Med Clin North Am. Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. Patients usually are symptomatic at serum levels of 1.

Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED

Explainers Understanding Congenital Heart Disease. Infection, particularly pneumonia, urinary tract infection, and sepsis 4 Inadequate insulin treatment or noncompliance 4 New-onset diabetes 4 Cardiovascular disease, dkx myocardial infarction 5.

This allows continued insulin administration until ketonemia is controlled and also helps to avoid iatrogenic hypoglycemia. Diary from a Week in Practice. 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.

Patients typically improve mentally with initial treatment of DKA, but then dma worsen.


Diabetes mellitus during interferon therapy for chronic viral hepatitis. If the serum osmolality is less than mOsm per kg mmol per kgetiologies other than DKA should be considered.

The laboratory tests needed to confirm the presence of diabetic ketoacidosis and to screen for precipitating events are summarized in Table 1 4 and Figure 2. 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 Unofficial document if printed.

Many patients with diabetes die from diabetic ketoacidosis DKA every year. Long-acting insulin normally is stopped during treatment of DKA. Disclaimer The following information, i. If pancreatitis is suspected, contrast-enhanced computed tomography CT may be useful for flowsheey in selected patients. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. 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.

Cerebral edema is less common in adults than in children, and there are no studies in adults rka report. For patients dks are unable to eat, intravenous insulin may be continued to maintain the blood glucose in a target range i.

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