ABC, VS, level of dehydration; Mental status, neuro exam, GCS; Risk for cerebral edema; CR monitor, VS q 15 min, I/O q 1 hr; Start DKA Flow Sheet. IV Access. Diabetic ketoacidosis (DKA) though preventable remains a frequent and life written and accompanied by a practical and easy to follow flow chart to be used in. Diabetic. Ketoacidosis. DKA. Resource Folder. May by Eva Elisabeth Oakes, RN, and Dr. Louise Cole, Senior Staff Specialist.
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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.
Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED
Read the full article. 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.
National Diabetes Data Flpwsheet. 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. DKA Protocol Page printed: Easily digestible liquid diets when sick. 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.