Medication
Management of adult diabetic ketoacidosis 1 Fluid therapy. 2 Insulin therapy. 3 Potassium, bicarbonate, and phosphate therapy. 4 Treatment of DKA in dialysis patients. 5 Metabolic treatment targets. 6 ... (more items)
Therapy
Since illness can trigger DKA, it’s important to know what to do if you get sick before it happens so that you are prepared. See your healthcare provider regularly: It’s important to see your healthcare provider regularly to be sure that your diabetes management plan is working.
Self-care
DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.
Nutrition
Medications such as diuretics, beta-blockers, corticosteroids, antipsychotics, and/or anticonvulsants may affect carbohydrate metabolism and volume status and, therefore, could precipitate DKA.
How to manage adult diabetic ketoacidosis (DKA)?
What should I do if I get sick before DKA?
What is DKA and how does it affect your body?
Which medications may precipitate diabetic ketoacidosis (DKA)?
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How to prevent DKA?
Prevent DKA. DKA is a serious condition, but you can take steps to help prevent it: Check your blood sugar often, especially if you’re sick. Keep your blood sugar levels in your target range as much as possible. Take medicines as prescribed, even if you feel fine.
What is DKA in diabetes?
DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too ...
What does DKA mean in Spanish?
Español (Spanish) minus. Related Pages. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated right away. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes.
What causes DKA in diabetics?
Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. Other causes of DKA include: Heart attack or stroke. Physical injury, such as from a car accident. Alcohol or drug use. Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).
What happens when you have too many ketones?
When too many ketones are produced too fast, they can build up to dangerous levels in your body. Read on to learn more about DKA, how you can prevent DKA, and how to treat it if needed.
Can you test for ketones if you have DKA?
You should also test for ketones if you have any of the symptoms of DKA. Call your doctor if your ketones are moderate or high. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated immediately.
Early identification and management are key to good outcomes
Compare onset, diagnosis, and treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state.
DKA and HHS: Head-to-head comparison
This side-by-side comparison highlights the differences and similarities between diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS).
Signs and symptoms
DKA typically evolves rapidly with initial signs and symptoms of polyuria, polydipsia, fatigue, abdominal pain, nausea, and vomiting. Over time, mental status changes may arise, leading to coma.
Lab findings
Laboratory findings include hyperglycemia (blood glucose typically >250 mg/dL and frequently 350 to 500 mg/dL) with low bicarbonate (<15 mEq/L) and an elevated anion gap (>12). Both urine and serum ketones are elevated, as is ß-hydroxybutyrate. If the patient is dehydrated, blood urea nitrogen and creatinine will be elevated.
Management
DKA treatment goals include restoring volume status and peripheral perfusion, improving glycemic control, and correcting electrolyte imbalances and ketosis. This is done by administering I.V. regular insulin and I.V. fluids. In addition, underlying causes must be identified and treated.
Treating DKA outside of the ICU
Managing diabetic ketoacidosis (DKA) in the ICU with I.V.
Resolution and transition to subcutaneous insulin
DKA is considered resolved with ketoacidosis correction, not improved glycemic control alone. The American Diabetes Association considers DKA resolved when two of the following occur: anion gap normalized (<12 mEq/L), bicarbonate ≥15 mEq/L, and pH >7.3.
What are the therapeutic goals of DKA?
The therapeutic goals of DKA management include optimization of 1) volume status; 2) hyperglycemia and ketoacidosis; 3) electrolyte abnormalities; and 4) potential precipitating factors. The majority of patients with DKA present to the emergency room. Therefore, emergency physicians should initiate the management of hyperglycemic crisis while a physical examination is performed, basic metabolic parameters are obtained, and final diagnosis is made. Several important steps should be followed in the early stages of DKA management: 1 collect blood for metabolic profile before initiation of intravenous fluids; 2 infuse 1 L of 0.9% sodium chloride over 1 hour after drawing initial blood samples; 3 ensure potassium level of >3.3 mEq/L before initiation of insulin therapy (supplement potassium intravenously if needed); 4 initiate insulin therapy only when steps 1–3 are executed.
Why is bicarbonate not indicated in mild and moderate forms of DKA?
Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy.3, 8The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies.
How many hospitalizations for diabetic ketoacidosis in 2009?
In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars.
What is the name of the regimen that contains both long-acting and short-acting insulin?
The regimen containing both long-acting and short-acting insulin is called a basal-bolus insulin regimen; it provides physiological replacement of insulin. If a patient used insulin prior to admission, the same dose can be restarted in the hospital.
Is ketoacidosis a type 1 or 2 diabetes?
Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making ...
Can DKA cause hypokalemia?
A “normal” plasma potassium concentration still indicates that total body potassium stores are severely diminished, and the institution of insulin therapy and correction of hyperglycemia will result in hypokalemia.
What is a DKA?
Diabetic Ketoacidosis (DKA) is an acute, potentially life-threatening complication of diabetes mellitus. For the most part, DKA occurs in people with type 1 diabetes, but it can happen in folks with type 2 diabetes almost as often. DKA is the result of an inadequate amount of insulin. Insulin allows the body to use its major fuel source (glucose) for energy. Since glucose can no longer be burned, it reaches high levels in the bloodstream. This causes increased urine production and dehydration. About 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. When there is not enough insulin, the body burns fat instead. Fat breaks down into acids which in turn produce toxic acidic substances known as ketones. These build in the bloodstream causing a dangerous situation. Loss of potassium and other salts which the body needs in the excessive urination is also common. DKA is therefore a medical emergency which if untreated can result in coma and possibly death. In the early stages, it may be possible to treat DKA at home, but if it is more advanced, management should take place in a properly equipped setting such as a hospital. The keys to prevention of DKA include awareness of its warning signs along with frequent blood glucose monitoring and checking urine or blood ketone levels as needed. Causative factors The most common events that cause a person with diabetes to develop diabetic ketoacidosis are: Infection such as diarrhea, vomiting, and/or high fever (40%), Missed, inadequate, or “bad” insulin (25%), New diagnosis or previously unknown diabetes (15%). Various other causes: pregnancy, heart attack, stroke, trauma, stress, alcohol abuse, drug abuse, and surgery. Approximately 5% to 10% of cases have no identifiable cause. Signs and Symptoms Continue reading >>
What is a diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>
What are the symptoms of DKA?
Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, ...
What is the pH of ketoacidosis?
1.) A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30) , and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L).
What happens when your glucose level decreases?
As the glucose level decreases in hypoglycemia , the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis.
What are the symptoms of hyperglycemia?
Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes. A nurse administers the prescribed regular insulin to a client in diabetic ketoacidosis.
Is NPH insulin an intermediate or rapid acting insulin?
NPH insulin is an intermediate-acting insulin; rapid-acting insulin is indicated in an emergency.
Does insulin glargine reverse ketoacidosis?
Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose. The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L).
Early Identification and Management Are Key to Good Outcomes.
Dka
Signs and Symptoms
Lab Findings
Specialist to consult
Management
Resolution and Transition to Subcutaneous Insulin
- If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: 1. Fluid replacement.You'll receive fluids — either by mouth or through a vein — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute th...
Recurrent Dka and Prevention
Special Considerations
HHS
Prevent Future Admissions