What should be included in patient education about diabetic ketoacidosis (DKA)?
May 01, 2003 · Administering hypertonic dextrose (1 litre 10% dextrose + 40 units insulin at 250 ml/h) rather than isotonic dextrose (1 litre 5% dextrose + 10 units insulin at 250 ml/h) may accelerate the clearance of ketone bodies but also causes a rise in [glucose] without an additional improvement in blood pH or bicarbonate. 8 Insulin Type of insulin
How is insulin used to treat diabetic ketoacidosis?
Aug 23, 2021 · having the syringe contain regular insulin first prevents the need to withdraw the regular insulin into a syringe that contains nph insulin and inadvertently contaminating the regular insulin vial with the longer-acting nph insulin; contaminating regular insulin with nph insulin will reduce the speed at which the regular insulin functions, which …
Can we manage diabetic ketoacidosis in adults in the emergency department?
starting insulin drip Starting dose 0.05 to 0.1 units/kg/hr Titrate insulin by 0.01 units/kg/hr to keep Blood Glucose between 150-300 If patient is delayed being assigned an inpatient bed more than 2 hours consider utilizing DKA Guidelines-Critical Care Reassess the appropriateness of Care Guidelines as condition changes. This guideline is a tool
Which fluids are used in the initial management of diabetic ketoacidosis (DKA)?
Nov 11, 2020 · Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
What insulin is used for ketoacidosis?
Only short-acting insulin is used for correction of hyperglycemia in DKA. The optimal rate of glucose decline is 100 mg/dL/h. The blood glucose level should not be allowed to fall lower than 200 mg/dL during the first 4-5 hours of treatment.Jan 19, 2021
Which insulin is given in emergency?
Critically ill patients may be given insulin, with a loading dose of regular insulin (0.1 units/kg body weight to a maximum of 10 units), followed by an infusion of regular insulin (0.1 units/kg body weight/hour, to a maximum of 10 units/hour)15,16.Mar 1, 2014
How is diabetic ketoacidosis treated in emergency?
Treatment usually involves:Fluid replacement. You'll receive fluids — either by mouth or through a vein — until you're rehydrated. ... Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. ... Insulin therapy.Nov 11, 2020
What is the insulin preparation of choice in diabetic ketoacidosis?
Intravenous infusion is a preferred route of insulin delivery in patients with DKA. Insulin infusion without initial volume resuscitation is not advised as it may only worsen dehydration.Jun 30, 2014
When should emergency insulin be given?
If their ketones are high, they should call their doctor. If they have serious signs, take them to the emergency room or urgent care right away....The person may have:Not injected enough insulin, or needs more than usual.Not eaten enough food.Had an insulin reaction (low blood sugar) while they were sleeping.Nov 6, 2020
When is ketoacidosis an emergency?
Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated immediately. Go to the emergency room or call 911 right away if you can't get in touch with your doctor and are experiencing any of the following: Your blood sugar stays at 300 mg/dL or above. Your breath smells fruity.Mar 25, 2021
How do you prepare insulin infusion?
Mix 250 units of regular human insulin in 250 mL of normal saline (1 U/mL). Flush approximately 30 mL through the line prior to administration. Do not use a filter or filtered set with insulin. Piggyback the insulin drip into intravenous fluid using an intravenous infusion pump with a capability of 0.1 mL/hr.Jan 31, 2020
What are the key nursing responsibilities when treating DKA?
Key areas in the management of DKA include:Restoring circulatory volume;Insulin therapy (fixed-rate intravenous insulin infusion);Correcting metabolic acidosis and electrolyte imbalances;Identifying and treating precipitating factors;Early involvement of the diabetes specialist team (JBDS, 2013).Feb 28, 2014
What insulin can be given IV?
What insulin can be given intravenously? The only type of insulin that is given intravenously is human regular insulin. A rapid-acting insulin analog is unnecessary in intravenous insulin administration because the insulin is delivered directly into the bloodstream and takes immediate effect.Sep 3, 2020
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.
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.
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 ...
What is the most common electrolyte derangement that occurs during the treatment of DKA?
Significant hypokalaemia is the most common life threatening electrolyte derangement that occurs during the treatment of DKA. Intravenous potassium replacement will be required after insulin is given as potassium will move into cells. Potassium replacement should not be started before insulin treatment; extracellular levels may otherwise rise dangerously high. Potassium replacement should be given as soon as insulin and fluid are started and the [K] level is known to be below the upper limit of the reference range. Regimens for potassium supplementation have not been formally evaluated. One suitable regimen for potassium replacement has been proposed 10:
What are the symptoms of insulin resistance?
Polyuria, polydipsia, and weakness are usually present. Nausea, vomiting, or abdominal pain may predominate. If the patient is already being treated with insulin, there may be a history of reduced or omitted insulin.
Is DKA the first presentation of diabetes?
DKA may be the first presentation of diabetes. Insulin error (with or without intercurrent illness) is the most common precipitating factor, accounting for nearly two thirds of cases (excluding those where DKA was the first presentation of diabetes mellitus). 2
Is DKA a clinical diagnosis?
There are no specific clinical signs that confirm or refute the diagnosis of DKA. The diagnosis is comparatively straight forward where there is a clear history that the patient has diabetes but can cause serious diagnostic difficulty where the patient is unconscious or DKA is the first presentation of diabetes (a past history of diabetes mellitus will be absent in 1 in 10 patients). The possibility of DKA (or other metabolic acidosis) should be considered whenever assessing a patient who presents with “hyperventilation” 4 and it is always essential to measure the blood glucose early in the resuscitation of any unconscious patient.
Is DKA a life threatening disease?
DKA is a complex life threatening problem and the management should not be left to inexperienced staff. There should be early consultation between A&E staff and specialist diabetes teams. Patients with DKA need four things;
Does bicarbonate help with acidosis?
Severe acidosis has adverse effects on many organs, especially the brain and the heart. It may, therefore, seem appealing to give bicarbonate as treatment for the metabolic acidosis that occurs in DKA. There is no evidence to support this. Studies (not RCTs) have failed to find evidence of faster biochemical recovery with bicarbonate treatment even in severely patients. 11–14 One prospective study found no metabolic benefits from bicarbonate administration and that bicarbonate (1 litre 150 mM sodium bicarbonate over one hour) delayed the fall in total ketone bodies and lactate levels. 15
Does phosphate affect DKA?
Phosphate levels are affected in DKA in much the same way as potassium (that is, extracellular shift but depleted total body levels). A small study found that the addition of phosphate to standard treatment did not reduce the time taken to reach recovery indices of bicarbonate, pH, or glucose. 16 Differences in magnesium and 2,3DPG levels and in P50 (the Pa o2 at which haemoglobin is 50% saturated) were not statistically significant. In another study phosphate supplementation (15 or 45 mmol) did not affect the rate of correction of [glucose], [bicarbonate] or pH. 17
What to do if you have diabetic ketoacidosis?
If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and order blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis.
What tests are done to determine if you have ketoacidosis?
Tests might include: Blood electrolyte tests. Urinalysis. Chest X-ray.
What happens if you don't have enough insulin?
If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise ( hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level.
What happens if your blood sugar is 200?
When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
How do you get electrolytes?
You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally. Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein .
What are the therapeutic goals of diabetic ketoacidosis?
The therapeutic goals for diabetic ketoacidosis consist of improving circulatory volume and tissue perfusion, reducing blood glucose and serum osmolality toward normal levels, clearing ketones from serum and urine at a steady rate, correcting electrolyte imbalances and identifying precipitating factors. A suggested flow sheet for monitoring therapeutic response is provided in Figure 3. 6
How long does subcutaneous insulin last?
When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started. The half-life of regular insulin is less than 10 minutes. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued. 1, 22 A protocol for the administration of subcutaneous insulin is included in Figure 2.
Is a physical exam necessary for a diabetic?
The history and physical examination continue to be important aspects of management. Even in comatose patients, information documenting a history of diabetes or insulin therapy may be available. The physical examination can provide supportive evidence for the diagnosis of diabetic ketoacidosis and can point to precipitating factors ( Table 2). 3, 4
Can you take bicarbonate with insulin?
In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy. 1, 4, 8, 16, 17 Insulin administration inhibits ongoing lipolysis and ketone production and also promotes the regeneration of bicarbonate.
Is there a randomized prospective study for diabetic ketoacidosis?
No randomized prospective studies have evaluated the optimal site of care for patients with diabetic ketoacidosis. The response to initial therapy in the emergency department can be used as a guideline for choosing the most appropriate hospital site (i.e., intensive care unit, step-down unit, general medical ward) for further care.
What should be included in a sick day management program?
An educational program should include sick-day management instructions (i.e., for any illness that alters routine care), including the use of short-acting insulin, blood glucose and urinary ketone monitoring, and the use of a liquid diet containing carbohydrates and salt. Patients should not discontinue insulin therapy when they are ill, and they should contact their physician early in the course of illness. 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.
Does osmotic diuresis cause phosphate loss?
Osmotic diuresis leads to increased urinary phosphate losses. During insulin therapy, phosphate reenters the intracellular compartment, leading to mild to moderate reductions in the serum phosphate concentration. Adverse complications of hypophosphatemia are uncommon and occur primarily in patients with severe hypophosphatemia (a serum phosphate concentration of less than 1.0 mg per dL [0.32 mmol per L]).