Table of Contents
What IV do you give for DKA?
FLUID REPLACEMENT The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.
What do you do for a DKA patient?
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.
Why don’t you intubate DKA?
(Avoid) Intubating the DKA Patient Furthermore, these patients with profound metabolic acidosis are at risk of circulatory collapse peri-intubation as periods of apnea during intubation will cause their pCO2 levels to rise rapidly, worsening the acidosis.
How do you close the gap in DKA?
Begin therapy with fluid resuscitation, preferably balanced crystalloids. Ensure serum potassium is normal or high before initiating insulin. Insulin infusion at 0.14 U/kg/hr IV is efficacious with no bolus. Long acting insulin can assist with transitioning to SC insulin therapy when provided early in management.
Can ringer lactate be given in DKA?
Ringer’s lactate is an alternative choice for initial fluid resuscitation, but may exacerbate the high lactate to pyruvate ratio in patients in DKA, and may cause hyperkaleamia.
When do you give Bicarb to DKA?
Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9.
What are the key nursing responsibilities when treating DKA?
Nursing Management Monitor vitals. Check blood sugars and treat with insulin as ordered. Start two large-bore IVs. Administer fluids as recommended. Check electrolytes as potassium levels will drop with insulin treatment. Check renal function. Assess mental status. Look for signs of infection (a common cause of DKA).
How do pediatrics manage DKA?
Key points. Treatment of DKA requires first and foremost fluid resuscitation with 0.9% saline, followed by replacement for 5%–10% dehydration, depending on severity, and maintenance with 0.45% saline, and early and adequate K replacement.
What are the diagnostic criteria for DKA?
The diagnostic criteria for diabetic ketoacidosis are: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) blood glucose over 11 mmol /l or known diabetes mellitus. venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 (1).
What is the anion gap for DKA?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
When do we use LR and NS?
LR is preferred to NS in select ED presentations, such as DKA. LR will not worsen hyperkalemia and the acidosis from NS may in fact be more detrimental. LR does contain sodium lactate but will not contribute to clinically significant worsening lactic acidosis. NS is preferred to plasma-lyte in patients with TBI.
When is the gap closed in DKA?
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
Why is the anion gap important in DKA?
The anion gap helps differentiate hyperchloremic metabolic acidosis (normal AG) from high AG metabolic acidosis. In hyperchloremic metabolic acidosis, there is an increase in plasma chloride equivalent to the fall in plasma bicarbonate, so that the sum of these two anions remains unchanged.
What is the sliding scale for insulin?
The term “sliding scale” refers to the progressive increase in pre-meal or nighttime insulin doses. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.
Is LR or NS better for DKA?
In this subgroup analysis of 2 cluster randomized clinical trials of adults presenting to the ED with DKA, treatment with balanced crystalloid solutions (largely lactated Ringer’s) was associated with more rapid resolution of DKA and discontinuation of insulin infusion than saline.
Can you give lactated ringers to a diabetic?
In 1978, Thomas and Alberti provided limited evidence that the use of Hartmann’s solution—which is similar in composition to lactated Ringer’s solution (LR)—causes transient elevation of blood glucose levels in diabetic patients and cautioned against the use of any lactate-containing intravenous (IV) fluid replacement.
Why does HCO3 decrease in DKA?
Acidosis in DKA is due to the overproduction of β-hydroxybutyric acid and acetoacetic acid. At physiological pH, these 2 ketoacids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels.
How do you give bicarbonate in DKA?
Although no prospective randomized trials have been conducted on patients with severe DKA, the American Diabetes Association recommends the administration of 100 mmol sodium bicarbonate in 400 mL sterile water with 20 mEq of KCl to patients with a pH of less than 6.90 until the pH rises above 7.00[5].
Do you treat DKA with bicarb?
These patients don’t need bicarbonate – what they need is maximally aggressive management of their DKA. There is no evidence that bicarbonate works as a treatment of ketoacidosis.
What is honk in diabetes?
Hyperglycaemic hyperosmolar non-ketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes (above 33 mmol/L). Hyperglycaemic hyperosmolar non-ketotic coma is a short term complication requiring immediate treatment by a healthcare professional.
