Scribd
Upload
15 views14 pages

Dka MX

Best notebook for Diabetic Ketoacidosis Management

Uploaded by

Arjudev Whrivo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
15 views14 pages

Dka MX

Best notebook for Diabetic Ketoacidosis Management

Uploaded by

Arjudev Whrivo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
You are on page 1/ 14
Fluid replacement + 0.9% Normal saline (NaCl) IV +1 Lover 1 hr (If systolic BP <90 mm Hg : 500 ml over 10-15 min, then reassess, if still low, repeat and hemodynamic monitoring/use of pressors) +1 Lover 2 kr +1 Lover 2 hrs +1 Lover 4 hr +1 Lover 4 hrs +1 Lover 6 hrs Fluid replacement... * When CBG <14 rimol/L, add 10% glucose 1 L 8 hrly (125 mi/hr) * If serum Na >155 mmol/L, .45% NS should be used. * Subsequent choice of fluid replacement depends on state of dehydration, serum electrolytes, urine output, blood glucose level. * Typical requirement is 6 L in first 24 hrs but be more cautious in older or young people, pregnant, heart or renal failure. Short acting/soluble insulin * Hourly fall of blood glucose should be 3 mmol/L * Target BG is in between 8.3-11.1 mmol/L until resolution of DKA. Insulin in limited facility + If IV insulin is not feasible : 10-20 units of soluble insulin IM followed by 5 units hourly. Transition from IV to SC insulin ition from IV to SC insulin therapy : if- * Patient is clinically stable * Patient is biochemically stable * Patient able to take oral food and drink normally Calculating dose of SC insulin + calculate total insulin required in last 6 hrs (eg . if patient getting 2 U/hr so in last 6 hr he got 2 * 6 = 12 units) * So 24 hrs insulin requirement 12 * 4= 48U . = 40U/day * eg. Inj. Gensulin R (Regular insulin) 100 6+ 6+ 6 and Inj. Gensulin N (NPH) 100 10+0+10 or Inj. Novorapid (Aspart) 6+ 6+ 6 and Inj. Lantus (Glargine) 0+ 0+ 20 Precaution to start SC insulin +The very short half life of IV insulin necessitates administering the first dose of SC insulin before discontinuation of IV inst * A combination of short/rapid and intermediate/long acting insulin is preferred. Potassium replacement * Depends on plasma level of K*. Add KCL except for first saline (1 L) bag. * Aim to maintain serum K* 4-5.5 mmol/L. + ECG monitoring or periodic tracing helpful to look cardiac toxicity. Plasma K* (mmol/L) KCL replacement (mmol/L of infusion) 3.5 40 until K* >3.5 with hold insulin 3.5-5.5 40 >5.5 0: patient is anuric not to give Potassium replacement in limited facility + Add KCL except for first saline (1 L) bag. * ECG monitoring or periodic tracing helpful to guide. Proper nursing care + NG tube if obtunded or persistent vomiting * Antibiotic if infection demonstrated or suspected Monitoring of DKA patient * Capillary BG and ketone testing (blood/urine) every hour until stable + ECG monitoring * Insertion of central venous line if CVS is compromised * Other tests as required Complications of Diabetic ketoacidosis * Acute circulatory failure * Hypokalemia and hyperkalemia + latrogenic hypoglycemia + Pulmonary oedema Cause of death of DKA * Cardiovascular collapse * Acidosis * Cerebral edema * Hypokalemis (insulin induced K* flux and unnecessary HCO3 infusion) Prognostic factors of DKA * Arterial PH <7 * Serum bicarbonate <10 mEq/L * Blood ketones >6 mmol/L + Anion gap >12 + Hypokalemia on admission (<3.5 mmol/L) * Oxygen saturation <92% on air + Systolic BP <90 mm Hg + Heart rate >100 or <60 beats/min * Glasgow coma scale score <12

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy