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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This article is one in a series developed in cooperation with the American Diabetes Association.

DKA Protocol

Am J Med Sci. Guest editors of the series are Bruce Zimmerman, M. Regular insulin should be used intravenously. Either of these treatments should be continued until the blood glucose level falls by 50 to 70 mg per dL. Half of the fluid resuscitation volume is initially replaced quickly over the first eight hours, with the rest being administered over the next sixteen hours.

When the blood glucose concentration is approximately mg per dL The insulin and fluid regimens are continued flowseet ketoacidosis is controlled. Initial presentation of diabetes mellitus.


Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. The osmotic diuresis can cause a significant loss of fluid, leading to severe dehydration and circulatory collapse.

ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis

Acidosis increases potassium levels and glucose administered with insulin lowers them. Long-acting insulin normally is stopped during treatment of DKA. Bacterial cultures of urine, blood, throat, or other sites of suspected infection.

Therefore, they have fewer ketones available for the regeneration of bicarbonate during insulin administration.

Diabetic Ketoacidosis – – American Family Physician

Guest editor of the series is Eric Henley, M. This content is owned by the AAFP. If surgery is necessary, the timing needs to be individualized for each patient with input from a surgical consultant. Information from references 4 through A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis.

This dreaded treatment complication occurs in approximately 1 percent of children with diabetic ketoacidosis.

Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED

B 383940 Low phosphate levels can cause problems, but phosphate does not need to be given routinely. DKA is caused by reduced insulin levels, decreased glucose use, and increased gluconeogenesis from dja counter regulatory hormones, including catecholamines, glucagon, and cortisol. For this reason, there are varying degrees of severity with DKA: Cerebral oedema during treatment of diabetic ketoacidosis: The amount of fluid resuscitation required in severe DKA is often the amount of fluid that is lost around six to ten litres.

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Hyperchloremia is a common but transient finding that usually requires no special treatment.

Bicarbonate therapy lowers potassium levels; therefore, potassium needs to be monitored carefully. Endocrinol Metab Clin North Am.

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The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors.

Pickup J, Keen H. Although the phosphate level frequently is low in patients with DKA, good-quality studies have shown that routine phosphate replacement does not improve outcomes in DKA, and excessive replacement can lead to hypocalcemia.

When should determination of ketonemia be recommended? Blood urea nitrogen and creatinine. It also leads to a diuresis in which water losses exceed sodium chloride losses.