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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There were no significant differences in outcomes between the aspart and intravenous insulin regimens. A small percentage of patients who have diabetic ketoacidosis present with metabolic acidosis and a normal anion gap. Continue reading from May 1, Previous: DKA Protocol Page printed: Major components of the pathogenesis of diabetic ketoacidosis are reductions in effective concentrations of circulating insulin and concomitant elevations of counterregulatory hormones catecholamines, glucagon, growth hormone and cortisol.

Diabetic Ketoacidosis – – American Family Physician

Patients with known diabetes can typically be given the dosage they were receiving before the onset of diabetic ketoacidosis. Patients need to be educated on the risks of avoiding their insulin in order to prevent re-admission with DKA. Blood glucose should be evaluated every one to flowsheer hours until the patient is stable, and the blood urea nitrogen, serum creatinine, sodium, potassium, and bicarbonate levels should be monitored every two to six hours depending on the severity of DKA.

Address correspondence to Abbas E. Alteration in sensoria or mental obtundation.

Although the bicarbonate level typically is low, it may be normal or high in patients with vomiting, diuretic use, or alkali ingestion. If the patient is on an insulin pump, it should be stopped, and flowshret patient should be switched to an intravenous infusion.


Discharge The aim is to discharge the patient with sufficient education to prevent re-admission with DKA in the future.

Treat Potassium Due to the increased level of ketones in the body, there is an increased level of extracellular hydrogen ions acidic which are exchanged for intracellular potassium in an attempt to help the metabolic acidosis improve. Cessation of insulin infusion at night-time during CSII-therapy: B 383940 Low phosphate levels can cause problems, but phosphate does not need to be given routinely. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. Beta-hydroxybutyrate is a better measurement of the degree floowsheet ketosis than serum fowsheet.

We also welcome any suggestions to make this material more useful to your practice. Special education for patients on pump management. Dk the patient has significant hypertriglyceridemia, it can falsely lower glucose and sodium measurements by dilution.

When the serum potassium level is less than 3. Complications can include dehydration, hypovolaemia, hypotensionelectrolyte abnormalities, cardiac arrhythmias, cardiac arrest and cerebral oedema. Comparative study of different insulin regimens in management of diabetic ketoacidosis.

Common complications of DKA include hypoglycemia, hypokalemia, and recurrent hyperglycemia.

For example, in a patient with a serum glucose concentration of mg per dL A suggested flow sheet for monitoring therapeutic response is provided in Figure 3. Year Floweheet Medical, Although it can affect adults, it is more common in young patients, occurring in 0.

ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis

Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Low-dose insulin therapy typically produces a linear fall in the glucose concentration of 50 to 70 mg per dL per hour.


When intravenous access is unavailable, studies have found that giving the entire initial dose intramuscularly also is effective. To understand the symptoms of DKA and therefore how to manage it effectively, it is important to understand the pathophysiology of hyperglycaemia which is explained in the flowchart below: Easily digestible liquid diets when sick.

Omission of insulin or inadequate insulin. Hyperosmolar hyperglycemic state Am Fam Physician. Adult respiratory distress syndrome ARDS is a rare but potentially fatal complication of the treatment of diabetic ketoacidosis.

The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Diabetic ketoacidosis following glucagon therapy in acute pancreatitis.

The rightsholder did not grant rights to reproduce this item in electronic media. Fluid intake should be modified based on urinary output.

Fluid guidelines are summarized on the flowchart in Figure 1. Myocardial infarction is a precipitating cause of diabetic ketoacidosis that is especially important to look for in older patients with diabetes. The changes were introduced to reflect an increased understanding in the medical literature of factors leading to complications, particularly cerebral edema, which arise during the treatment of DKA in infants, children and adolescents.

A blood glucose concentration of less than mg per dL, a bicarbonate level of 18 mEq per L or greater, and a venous pH level of greater than 7. The replacement of insulin is the cornerstone of rectifying DKA as it allows the uptake of glucose as an energy source, thereby reducing hyperglycaemia and stopping the pathophysiology of gluconeogenesis.