Tygogrel It is observed primarily in people with type one diabetes insulin dependentbut it can occur in type two diabetes non-insulin dependent under certain circumstances. Association of diabetic ketoacidosis and acute pancreatitis: The beta-hydroxybutyrate level may not normalize during the first one to two days of treatment. Omission of insulin or inadequate insulin. Some authorities, however, recommend bicarbonate administration when the pH is less than 7. Diabetic ketoacidosis and hyperosmolar coma.
|Published (Last):||28 July 2008|
|PDF File Size:||4.24 Mb|
|ePub File Size:||16.1 Mb|
|Price:||Free* [*Free Regsitration Required]|
Vuzragore When the blood glucose concentration is approximately mg per dL In clinical situations in which continuous intravenous insulin cannot be administered, the recommended initial insulin dose is 0. Earn up to 6 CME credits per issue. Papilledema, hypertension, hyperpyrexia, and diabetes insipidus also may occur. Serum bicarbonate mEq per L. Sign up for the free AFP email table of contents. 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.
Patients who are able to drink can take some or all of their fluid replacement orally. Although it is important to monitor urinary output, urinary catheterization is not advised routinely. Admission to a step-down or intensive care unit should be considered for patients with hypotension or oliguria refractory to initial rehydration and for patients with mental obtundation or coma flowsheet hyperosmolality total osmolality of greater than mOsm per kg of water.
Adult respiratory distress syndrome ARDS is a rare but potentially fatal complication of the treatment of diabetic ketoacidosis. Guest editor of the series is Eric Henley, M.
Liver enzymes also are elevated frequently in patients with DKA because of unknown causes. The exact amount of potassium that is administered depends on the serum potassium concentration. A1C level may help determine whether this is an acute episode in a patient with well-controlled, undiagnosed, or poorly controlled diabetes.
Fluid intake should be modified based on urinary output. Home monitoring of ketones or beta-hydroxybutyrate. Lispro and aspart NovoLog flowsyeet are more expensive and do not work faster than regular insulin when given intravenously. It is observed primarily in people with type one diabetes insulin dependentbut it can occur in type two diabetes non-insulin dependent under certain circumstances.
Because there are no studies on patients with a pH level below 6. TABLE 4 Strategies to Prevent Flowshewt 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 flowsheey 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 The following information, i.
Long-acting insulin normally is stopped during treatment of DKA. In the rare patient who presents with hypokalemia, insulin therapy may worsen the hypokalemia and precipitate life-threatening cardiac arrhythmias. Hyperglycemia initially causes the movement of water out of cells, with subsequent intracellular dehydration, extra-cellular fluid expansion and hyponatremia. Onset of headache or mental status changes during therapy should lead to consideration of this complication.
Total serum osmolality is calculated using the following equation: The laboratory tests needed to confirm the presence of diabetic ketoacidosis and to screen for precipitating events are summarized f,owsheet Table 1 dkka and Figure 2.
Strength of Recommendations Key clinical recommendation Label References Comments Regular insulin by continuous intravenous infusion is preferred for moderate to severe diabetic ketoacidosis. Studies of patients with a pH level of 6.
Flowsbeet, particularly pneumonia, urinary tract infection, and sepsis 4 Inadequate insulin treatment or noncompliance 4 New-onset diabetes 4 Cardiovascular disease, particularly myocardial infarction dlowsheet. This version auto-calculates the fluid rates and has some pop-up screens to guide in the clinical evaluation of children presenting with DKA.
Management of Diabetic Ketoacidosis — — American Family Physician If pancreatitis is suspected, contrast-enhanced computed tomography CT may be useful for diagnosis in selected patients. Abdominal pain may be a symptom of ketoacidosis or part of the inciting cause of DKA, such as appendicitis or cholecystitis. 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 flowshet ketoacidosis pH of greater than 7.
Low-dose insulin therapy typically produces a linear fall in folwsheet glucose concentration of 50 to 70 mg per dL per hour. 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.
Flowshet 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. Patients typically improve mentally with initial treatment of DKA, but then suddenly worsen. Either of these treatments should be continued until the blood glucose level falls by 50 to 70 mg per dL. Myocardial infarction is a precipitating cause of diabetic ketoacidosis that is especially important to look for in older patients with diabetes.
Most 10 Related.
Flow Chart for Diabetic Ketoacidosis in Adults Management of
Shaktimuro There were no significant differences in outcomes between the aspart and intravenous insulin regimens. A small percentage of patients who have diabetic ketoacidosis present with metabolic acidosis and a normal anion gap. Continue reading from May 1, Previous: DKA Protocol Page printed: 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. Diabetic Ketoacidosis — — American Family Physician Patients with known diabetes can typically be given the dosage they were receiving before the onset of diabetic ketoacidosis. Patients need to be educated on the risks of avoiding their insulin in order to prevent re-admission with DKA. Blood glucose should be evaluated every one to flowsheer 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 DKA. Address correspondence to Abbas E.