Goals of treatment replace volume deficit correct ketosis and acidosis with continuous insulin replace electrolyte deficits replace free water deficit prevent hypoglycemia determine inciting. Diabetic ketoacidosis diagnosis and treatment mayo clinic. In hhs or moderate to severe dka, treatment can be initiated with an iv bolus of regular insulin 0. The epidemiology, pathogenesis, clinical features, evaluation, and diagnosis of these disorders are discussed separately. Treatment of diabetic ketoacidosis with subcutaneous. Diabetic ketoacidosis dka is a serious condition that can lead to diabetic coma passing out for a long time or even death. Diabetic ketoacidosis dka, resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. Management of diabetic ketoacidosis in adults queensland health.
The management of diabetic ketoacidosis in children the management of diabetic ketoacidosis in children. Improved patient education with increased blood glucose and ketone monitoring has led to partial treatment of dka. Precipitating factors for diabetic ketoacidosis in pregnancy protracted vomiting hyperemesis. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality.
Individual rates of bag 1 and bag 2 are dependent on glucose level with goal of maintaining glucose of 150300. Blood glucose bg 200 mgdl acidosis bicarbonate dka e. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetic ketoacidosis is a lifethreatening complication that affects people with diabetes. To assess the effect of phosphate replacement therapy on the course of diabetic coma, 24 patients with severe diabetic ketoacidosis and 16 patients with nonketotic hyperosmolar coma were randomly assigned either to standardized conventional treatment. Clinicians should understand the appropriate management and risks associated with treatment of children with diabetic ketoacidosis. Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but. Three major changes have occurred in the treatment of diabetic ketoacidosis during the past decade. Diabetic ketoacidosis symptoms, diagnosis and treatment.
Diabetic ketoacidosis dka critical care guideline two. Hypoglycemia is the most frequent complication with dka treatment arising secondary to the discrepancy between the availability of glucose to. Guidelines for management of diabetic ketoacidosis the lancet. It could be lifethreatening, but it usually takes many hours to. Prevention of hypophosphatemia by phosphate infusion. Emergency management of diabetic ketoacidosis in adults. Diabetic ketoacidosis dka care guidelines emergency. Patient demographics are changing and patients with dka. In this article, learn about the symptoms and underlying causes.
Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Identify and treat the cause of the dka precipitation. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known diabetes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis. Diabetic ketoacidosis dka is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 35%. It can happen when your blood sugar is too high for too long. The treatment for diabetic ketoacidosis is insulin, fluids and. Dka is the leading cause of death in children with type 1 diabetes 1, 2 and accounts for a significant proportion of admissions in adult patients with type 1 or type 2 diabetes 1, 3. Diabetic ketoacidosis causes, symptoms, treatment, and. Does patient have a diagnosis of hyperglycemic emergency6.
Treatment should not only consider lowering the blood glucose level but also should focus on the correction of any associated cvd risk factors such as smoking, hyperlipidemias, and obesity as well as monitoring of blood pressure and treatment. Number 5 march 1, 20 management of dka in adults figure 1. This protocol is to be used for the management of diabetic ketoacidosis dka in adults over the age of 16. Diabetic ketoacidosis carries a significant mortality rate and close monitoring is essential.
The management of diabetic ketoacidosis in adults our. Most patients with moderate to severe dka require insulin to restore homeostasis. Whatyoushouldknow diabeticketoacidosis dka isacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%. It can also occur in patients with other types of diabetes it can be. Kitabchi, phd, md 2 objective in this prospective, randomized, open trial, we compared the ef. Diabetic ketoacidosis dka, a lifethreatening complication of type 1 diabetes, is preventable but errors in the way it is managed are common and and associated with significant morbidity and mortality. If the potassium level is in the normal range, replacement can start at 10 to 15 meq potassium per hour. Guidelines for management of diabetic ketoacidosis. Diabetic ketoacidosis dka is a buildup of acids in your blood.
The current guidelines state that the most effective method of. Weve helped produce the management of diabetic ketoacidosis in adults, pdf. Acute management of diabetic ketoacidosis in adults this protocol is for the acute management of diabetic ketoacidosis in patients 16 years and over. Diabetic ketoacidosis is diagnosed by an elevated blood sugar glucose level, elevated blood ketones and acidity of the blood acidosis. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart guillermo e.
Treatment of diabetic ketoacidosis dkahyperglycemic. This clinical presentation is being encountered more frequently. Improved patient education with increased blood glucose and ketone monitoring has led to partial treatment of dka prior to admission with consequent lower blood glucose levels at. Pdf management of diabetic ketoacidosis researchgate. Youll receive fluids either by mouth or through a vein intravenously until youre rehydrated. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3.
Patient demographics are changing and patients with dka are now more likely to be obese or suffering with other insulinresistant states, including pregnancy. Diabetic ketoacidosis dka is the most common hyperglycemic emergency in patients with diabetes. Goals of therapy are to correct dehydration, correct acidosis and reverse ketosis. Insulin therapy and correction of acidosis will cause cellular uptake of potassium. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. Diabetic ketoacidosis dka con tinues to have high rates of morbidity and mortality despite advances in the treatment of dia betes mellitus. Due to its increasing incidence and economic impact related to the treatment. Management of diabetic ketoacidosis in adults age 16. Diabetic ketoacidosis dka care guidelines critical care. Dka can happen to anyone with diabetes, though its much more common in people with type 1 diabetes. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. Although persons with dka usually have a glucose level greater than 250 mg per dl, a few. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Clinicians should be aware of the etiology and clinical presentation of diabetic ketoacidosis.
Diabetic ketoacidosis dka care guidelines emergency department management inclusion criteria definition of dka. The biochemical criteria for the diagnosis of diabetic ketoacidosis dka are. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. Meticulous monitoring of the clinical and biochemical response to treatment is necessary so that timely adjustments in treatment can be made when indicated by the patients clinical or laboratory data e. Joint british diabetes societies guideline for the management of diabetic ketoacidosis. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Diabetic ketoacidosis american academy of pediatrics. Insulin infusion should be continued until acidosis has resolved, as.
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