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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TABLE 1 Causes of Diabetic Ketoacidosis Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis 4 Inadequate insulin treatment or noncompliance flowshdet New-onset diabetes 4 Cardiovascular disease, particularly myocardial infarction 5 Acanthosis nigricans 6 Acromegaly 7 Arterial thrombosis, including mesenteric and iliac 5 Cerebrovascular accident 5 Hemochromatosis 8 Hyperthyroidism 9 Pancreatitis 10 Pregnancy 11 Atypical antipsychotic agents 12 Corticosteroids 13 FK 14 Glucagon 15 Interferon 16 Sympathomimetic agents including albuterol Ventolindopamine Intropindobutamine Flowsyeetterbutaline Bricanyl17 and ritodrine Yutopar 18 Information from references 4 through 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 Association of diabetic ketoacidosis and acute pancreatitis: Flowsbeet perspectives on the use of continuous subcutaneous insulin infusion in the acute care setting and overview of therapy.
DKA primarily affects patients with type 1 diabetes, but also may occur in patients with type 2 diabetes, and is most often caused by omission of treatment, infection, or alcohol abuse. Prevention of another episode should be part of the treatment of DKA.
New-onset diabetes and ketoacidosis with atypical antipsychotics. Case monitoring of high-risk flwosheet. Salutary effects of modest fluid replacement in the treatment of adults flowshfet diabetic ketoacidosis.
It is prudent to withhold insulin therapy until the flowshee potassium concentration has been determined. Diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis and hyperglycemia.
The conditions that cause these metabolic abnormalities overlap.
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. Although it is not monitored routinely during treatment, the beta-hydroxybutyrate level usually is less floqsheet 1. A suggested flow sheet for monitoring response to therapy for diabetic ketoacidosis.
Diabetic Ketoacidosis – – American Family Physician
Exp Clin Endocrinol Diabetes. Treatment also flowshewt be directed at the underlying cause of the DKA, including antibiotics for suspected or identified infection. Patients who are able to drink can take some or all of their fluid replacement orally. Information from references 49 through Aug 01, Issue. Adverse complications of hypophosphatemia are uncommon and occur primarily in patients with severe hypophosphatemia a serum phosphate concentration of less than 1.
Plasma glucose mg per dL [mmol per L]. When the blood glucose level has dropped below mg per dL, the patient may be given fluid with 5 percent dextrose, such as 0. Want to use this article elsewhere? Cerebral edema is less common in adults than in children, and there are no studies in adults to report.
A few studies suggest possible harms. Cerebral oedema during treatment of diabetic ketoacidosis: Phosphate therapy in diabetic ketoacidosis. If dextrose is not given, further ketosis may occur. Diabetes mellitus during interferon therapy for chronic viral hepatitis.
Fetal death associated with severe ritodrine induced ketoacidosis. Supplemental short-acting insulin regimens. This article is one in a series developed in cooperation with the American Diabetes Association.
Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED
vka There is also an accompanying article entitled Diabetic Ketoacidosis in Children and Adolescents: Wall received fellowship training at the University of Alabama, Birmington. Symptomatic cerebral edema occurs primarily in pediatric patients, particularly those with newly diagnosed diabetes. Flowsbeet therapy in severe diabetic ketoacidosis. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the s.
Da patients who are unable to eat, 5 percent dextrose in hypotonic saline solution is continued at a rate of to mL per hour. Type 2 Related Content Diabetes. Kitabchi AE, Rumbak M. Hyponatremia needs to be corrected only when the sodium level is still low after adjusting for this effect. Most patients with DKA will need lifetime insulin therapy after discharge from the hospital.
Phosphorous and magnesium also may need to be replaced. Insulin therapy of diabetic ketoacidosis: Diary from a Week in Practice Next: A combined metabolic-nephrologic approach to therapy. There were no significant differences in outcomes between the aspart and intravenous insulin regimens. Bicarbonate therapy lowers potassium levels; therefore, potassium needs to be monitored carefully.
The half-life of regular insulin is less than 10 minutes. C 3 Cerebral edema is less common in adults than in children, and there are no studies in adults to report. Handbook of diabetes mellitus. With a special interest in all things cardiac and respiratory, Joanne currently works as an Intensive Care Clinical Educator within a dynamic and expanding bed unit, as well as an undergraduate teacher at a large reputable university in Melbourne.
A decreased level of consciousness may lead to an unprotected airway and compromised breathing. Bicarbonate therapy should not be given to adult patients with a pH level of 7. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. 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.