Diabetic Ketoacidosis

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• Diabetic ketoacidosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Diagnosis

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Treatment

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Step-wise approach to management of diabetic ketoacidosis

DKA treatment protocol according to ADA guidelines

Fluids

Bicarbonate

Insulin

Potassium

Hydration status

pH greater than equal to 6.9

pH less than 6.9

0.1 u/kg/B.WT. as IV bolus

0.14 u/kg/B.WT/hr as continous IV infusion

K < 3.3 mEq/L

K = 3.3 - 5.2 mEq/L

K > 5.2 mEq/L

Severe hypovolemia

Mild dehydration

Cardiogenic shock

0.1 u/kg/B.WT. as IV continous infusion

Hold insulin and give 20-30mEq/L of potassium until K+ > 3.3mEq/L

Give 20-30mEq/L in each liter of IV fluids to maintain serum K 4-5mEq/L

Do not give potassium but check serum potassium every 2 hours

0.9% Nacl (1L/hr) as IV infusion

Check corrected serum sodium

Hemodynamic monitoring and add pressors accordingly

If serum glucose does not fall by 10 % within one hour of therapy then give 0.14 U/Kg as IV bolus and continue previous regimen

High serum Na (>145 mEq/L)

Normal serum Na (135-145 mEq/L)

Low serum Na (< 135 mEq/L)

When serum glucose drops to 200 mg/dl, reduce regular insulin to 0.02-0.05 U/Kg/hour, or give rapid-acting insulin at 0.1 U/kg SC every 2 hours, maintain serum glucose between 150 mg/dl to,200 mg/dl until resolution

0.45% NaCl (250-500 ml per hour depending on hydration status

0.9% NaCl (200-500 ml per hour) depending on hydration status

When serum glucose decreases to 200 mg/dl, switch to 5% dextrose with 0.45% NaCl at 150-250 ml/hour

Do's

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Don'ts

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References

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