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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Cerebral edema is a major complication that occurs primarily in children.
Many patients with diabetes die from diabetic ketoacidosis DKA every year. Cessation of insulin infusion at night-time during CSII-therapy: Acanthosis nigricans 6 Acromegaly 7 Arterial thrombosis, including mesenteric and iliac 5 Cerebrovascular accident 5 Hemochromatosis 8 Hyperthyroidism 9 Pancreatitis 10 Pregnancy He is also associate professor of medicine at the University of Tennessee, Memphis, College of Medicine, where he attended medical school and completed flowsbeet training.
Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes.
Complete blood count with differential. Patients typically improve mentally with initial treatment of DKA, but then suddenly worsen. The beta-hydroxybutyrate level may not normalize during the first one to two days of treatment.
Cooppan R, Kozak GP. Diabetes Metab Res Rev. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. A similar study 29 comparing subcutaneous lispro insulin fliwsheet a medical ward with an intravenous insulin drip in the intensive care unit showed similar outcomes, except for a 40 percent reduction in cost for patients treated in the medical ward.
Management of Diabetic Ketoacidosis – – American Family Physician
Furthermore, bicarbonate therapy carries some risks, dja hypokalemia with overly rapid administration, paradoxic cerebrospinal fluid acidosis and hypoxia.
In addition to alterations in magnesium metabolism from DKA, many patients with diabetes have taken medications such as diuretics that also may lower magnesium levels.
To understand the symptoms of DKA and therefore how to manage it effectively, it is important to understand flowsyeet pathophysiology of hyperglycaemia which is explained in the flowchart below:. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness.
Therefore, the use of bicarbonate in a patient with a pH greater than 7. Total serum osmolality is calculated using the following equation: Insulin may be mixed in a standard concentration of 1 U per 10 mL of normal saline.
Infection, insulin omission, and other problems that may have precipitated ketoacidosis should be treated. Blood glucose levels are monitored every four flowsheeg, and regular insulin is given subcutaneously every four hours using a sliding scale Figure 2.
Diabetic Ketoacidosis – – American Family Physician
The protocol and accompanying documents can be downloaded in a single document, the DKA Protocol Toolkitor as individual documents:. Studies of patients with a pH level of 6. Already a member or subscriber? The goal is to maintain the serum potassium concentration in the range of 4 to 5 mEq per L 4 to 5 mmol per L.
It is beneficial to review the reason for why the insulin may not have been taken and organise social support flowhseet rectify the issue in the future. Ellenberg and Rifkin’s Diabetes mellitus. See page for more information. Monitoring of oxygen saturation with pulse oximetry may assist in the management of such patients. Disclaimer The following information, i.
Hospital admission guidelines for diabetes. A standard laboratory work-up is listed in Table 3. Insulin therapy of diabetic ketoacidosis: Want to use this article elsewhere?
Patients should be monitored closely and frequently. Electrolytes with calculated anion gap and effective osmolality. It is prudent to withhold insulin therapy until the serum potassium concentration has been determined.