Diabetic Ketoacidosis (DKA) Treatment PDF

Algorithm C: adults who are unconscious and/or are having seizures and/or are very aggressive OR patients who are nil by mouth Assess the patient. - If the patient has an insulin infusion in situ, stop it immediately. The following two...

Algorithm C: adults who are unconscious and/or are having seizures and/or are very aggressive OR patients who are nil by mouth Assess the patient. - If the patient has an insulin infusion in situ, stop it immediately. The following two options are both appropriate: Glucagon 1mg IM (remembering that this may be less effective in patients prescribed SU therapy and may take up to 15min to work). - If IV access available, give 75mL of 20% glucose or 150mL of 10% glucose over 12– 15min. - Repeat capillary blood glucose measurement 10min later. - If blood glucose is 72mg/dl and the patient has recovered, give a long-acting carbohydrate. DO NOT omit insulin injection if due (dose review may be required). - If the patient was on IV insulin, continue to check blood glucose every 30min until it is above 63md/dl; then restart IV insulin after review of the dose regimen. Diabetic ketoacidosis DKA Hyperglycemiaketoacidosis ketonuria Definition; is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria.It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues, e causing them to accumulate in the blood and urine and turn the blood acidic. Causes of DKA in type 1 diabetes mellitus include the following: In 25% of patients, DKA is present at diagnosis of type 1 diabetes due to acute insulin deficiency Poor compliance Missed, omitted or forgotten insulin doses due to illness, vomiting or excess alcohol intake Bacterial infection and intercurrent illness (eg, urinary tract infection [UTI]) Klebsiella pneumoniae (the leading cause of bacterial infections precipitating DKA) Medical, surgical, or emotional stress Brittle diabetes Idiopathic (no identifiable cause) Mechanical failure of the insulin infusion pump Causes of DKA in type 2 diabetes mellitus include the following: Intercurrent illness (eg, myocardial infarction, pneumonia, prostatitis, UTI) Medication (eg, corticosteroids, pentamidine, clozapine) DKA has also been reported in people with type 2 diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. DKA also occurs in pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy.  to Symptoms mental status. 00 polyuria, polydipsia, nausea, vomiting, abdominal pain, malaise ,fatique tachypnea and altered Beside with features of precipitating illness if present. Effects on vital signs that are related to DKA may include the following: signs Tachycardia Hypotension Tachypnea Hypothermia m o Fever, if infection is present am Specific signs of DKA may include the following: I Confusion 18 Coma Abdominal tenderness The diagnosis of DKA is dependent on the combined presence of three biochemical abnormalities: 1- Ketonaemia ≥3mmol/L or significant ketonuria (>2+). 2- Blood glucose >250mg/dl (ADA) (>200mg/dl according to NICE) or patient is known to have diabetes. 3- Bicarbonate ((HCO3−)