Hyperglycemic crises resident survival guide: Difference between revisions
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==Definition== | ==Definition== | ||
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* Admit the patient. If pH < 7.0, pt unconscious admit to ICU else may be shifted directly to floor. | * Admit the patient. If pH < 7.0, pt unconscious admit to ICU else may be shifted directly to floor. | ||
* Assess hydration status of the patient, treat as needed. | * Assess hydration status of the patient, treat as needed. | ||
* switch to Dextrose with normal saline once blood sugar falls to 200 mg/dL. | |||
* Check for complications from the condition itself as well as those developing due to therapy. | |||
==Don'ts== | ==Don'ts== | ||
* DO not stop i.v. insulin until DKA has resolved. | |||
* Do not stop i.v. insulin, as soon as s.c. insulin is administered, as it needs time to kick in. | * Do not stop i.v. insulin, as soon as s.c. insulin is administered, as it needs time to kick in. | ||
* DO not give insulin if K+ levels are below 3.5 mEq/ | * DO not give insulin if K+ levels are below 3.5 mEq/l, may further cause hypokalemia. | ||
* Do not use 0.9% NaCl if corrected Na+ levels > 145 mEq/l, use 0.45% instead. | |||
==References== | ==References== |
Revision as of 20:09, 25 November 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]
Definition
Diabetic ketoacidosis is a life threatening complication of untreated or inadequately treated Diabetes Mellitus, usually Type 1 but sometimes also seen in Type 2. It is a metabolic abnormality with hypoglycemia, metabolic acidosis and ketonuria/ketonemia. It is seen when there is lack of insulin in body, so that instead of sugars, fats are burned as fuel.
Causes
It sometimes occurs as an initial presentation in undiagnosed cases of type 1 DM, however it can also occur in people with type 2 DM. In both the types it may be precipitated by one or more of the following causes.
- Intercurrent illnesses - such as infections, is the most common risk factor precipitating DKA. Urinary tract infection's and Pneumonia being the 2 most common.[1]
- Inadequate dosage or complete lack of insulin, such as in non-compliant cases and those with newly diagnosed type 1 DM.[2][3]
- Myocardial infarction.
- Pregnancy.[4]
- Stress such as that caused from surgery, infections etc which leads to a release of stress hormones , which are counter-regulatory to insulin.[5]
- Dehydration.
Management
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Do's
- Check labs initially and every 2-4 hours.
- Check urine for ketones immediately with dipstick and send urine to lab for analysis.
- Initiate i.v. insulin as soon as the patient arrives and satisfies criteria for DKA.
- Assess to understand what precipitated DKA and treat the cause.
- Admit the patient. If pH < 7.0, pt unconscious admit to ICU else may be shifted directly to floor.
- Assess hydration status of the patient, treat as needed.
- switch to Dextrose with normal saline once blood sugar falls to 200 mg/dL.
- Check for complications from the condition itself as well as those developing due to therapy.
Don'ts
- DO not stop i.v. insulin until DKA has resolved.
- Do not stop i.v. insulin, as soon as s.c. insulin is administered, as it needs time to kick in.
- DO not give insulin if K+ levels are below 3.5 mEq/l, may further cause hypokalemia.
- Do not use 0.9% NaCl if corrected Na+ levels > 145 mEq/l, use 0.45% instead.
References
- ↑ Umpierrez, GE.; Kitabchi, AE. (2003). "Diabetic ketoacidosis: risk factors and management strategies". Treat Endocrinol. 2 (2): 95–108. PMID 15871546.
- ↑ Wolfsdorf, J.; Craig, ME.; Daneman, D.; Dunger, D.; Edge, J.; Lee, W.; Rosenbloom, A.; Sperling, M.; Hanas, R. (2009). "Diabetic ketoacidosis in children and adolescents with diabetes". Pediatr Diabetes. 10 Suppl 12: 118–33. doi:10.1111/j.1399-5448.2009.00569.x. PMID 19754623. Unknown parameter
|month=
ignored (help) - ↑ Wolfsdorf, J.; Glaser, N.; Sperling, MA. (2006). "Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association". Diabetes Care. 29 (5): 1150–9. doi:10.2337/diacare.2951150. PMID 16644656. Unknown parameter
|month=
ignored (help) - ↑ Parker, JA.; Conway, DL. (2007). "Diabetic ketoacidosis in pregnancy". Obstet Gynecol Clin North Am. 34 (3): 533–43, xii. doi:10.1016/j.ogc.2007.08.001. PMID 17921013. Unknown parameter
|month=
ignored (help) - ↑ MacGillivray, MH.; Bruck, E.; Voorhess, ML. (1981). "Acute diabetic ketoacidosis in children: role of the stress hormones". Pediatr Res. 15 (2): 99–106. doi:10.1203/00006450-198102000-00002. PMID 6789292. Unknown parameter
|month=
ignored (help) - ↑ Lambertus, MW.; Murthy, AR.; Nagami, P.; Goetz, MB. (1988). "Diabetic ketoacidosis following pentamidine therapy in a patient with the acquired immunodeficiency syndrome". West J Med. 149 (5): 602–4. PMID 3150636. Unknown parameter
|month=
ignored (help) - ↑ Ai, D.; Roper, TA.; Riley, JA. (1998). "Diabetic ketoacidosis and clozapine". Postgrad Med J. 74 (874): 493–4. PMID 9926128. Unknown parameter
|month=
ignored (help)