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.
|Published (Last):||23 April 2005|
|PDF File Size:||18.22 Mb|
|ePub File Size:||4.66 Mb|
|Price:||Free* [*Free Regsitration Required]|
Bicarbonate therapy in severe diabetic ketoacidosis. Case Studies in International Travelers.
Management of Diabetic Ketoacidosis – – American Family Physician
If the patient is on an insulin pump, it should be stopped, and the patient should be switched to an intravenous floswheet. Levels correlate better with changes in arterial pH and blood bicarbonate levels than ketones, and were found to lead to better outcomes in one study of children.
No studies have found improved outcomes beyond slight increases in serum pH levels after bicarbonate has been administered.
Metabolic effects of bicarbonate in 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. A few studies suggest possible harms. 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 essential data can be obtained promptly in the emergency department. Address correspondence to Abbas E. Diabetic ketoacidosis Acta Paediatr Suppl. Kitabchi received his doctoral degree in medical sciences from the University of Oklahoma, Oklahoma City, where he also earned a medical degree at the College of Medicine. Fetal death associated with severe ritodrine induced ketoacidosis. As noted previously, however, overly rapid rehydration or overcorrection of hyperglycemia appears to increase the risk of cerebral edema.
More in Pubmed Citation Related Articles. When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started.
S95, with additional information from reference The major treatment of this condition is initial rehydration using isotonic saline with subsequent potassium replacement and low-dose insulin therapy.
It folwsheet observed primarily in people with type one diabetes insulin dependentbut it can occur in type two diabetes non-insulin dependent under certain circumstances. Management of Adults with Diabetic Ketoacidosis Figure 1. May 1, Issue.
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.
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. 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.
Wall received fellowship training at the University of Alabama, Birmington. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes.
The bicarbonate solution is administered over a one-hour period. A1C level may help determine whether this is an acute episode in a patient with well-controlled, undiagnosed, or poorly controlled diabetes. Regular insulin by continuous intravenous infusion is preferred for moderate to severe diabetic ketoacidosis. Phosphate therapy in diabetic ketoacidosis.
Case monitoring of high-risk patients. 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. Immediate access to this article. If pancreatitis is suspected, contrast-enhanced computed tomography CT may be useful for diagnosis in selected patients.
Hyperchloremic metabolic acidosis with a normal anion gap typically persists after the resolution of ketonemia. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. We hope that you will find these materials to be helpful in managing pediatric cases of diabetic ketoacidosis. If surgery is necessary, the timing needs to be individualized for each patient with input from a surgical consultant.
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.
The use of bicarbonate is not recommended in most patients. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis.
Diagnostic Triad of Diabetic Ketoacidosis The rightsholder did not grant rights to reproduce this item in electronic media.