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Diabetic Ketoacidosis: Therapy - Coggle Diagram
Diabetic Ketoacidosis: Therapy
key components
Fluid therapy
Goals
Restore intravascular volume
Correct hypovolemia with a fluid bolus
Restore interstitial & intracellular fluids
Correct dehydration with fluids over 12‐48 hrs
calculate with maintenance (40 – 60 ml/kg/day) + deficit (% x BW kg) + ongoing losses (10‐30 ml/kg/day)
critical to monitor patient status, adjust according to...
Blood pressure
BUN and creatinine
Weight
Physical examination
reduces the acidosis
moving potassium intracellular, can worsen hypokalemia.
Any balanced crystalloid solution
Electrolytes
KCl should always be supplemented on a sliding scale
Recheck K+ every 4‐6 hours until normal
supplement with K‐Phos if phosphorous is <1.5 mg/dL
Calculate potassium needs
Give ½ as KCl and ½ as K‐Phos
does not normalize, add magnesium sulfate to fluids
Insulin
critical for resolution of
Ketonemia
Glucosuria
Ketonuria
Fluid Loss
Electrolyte Depletion
Respiratory
CNS
GI
:warning: insulin will drop the potassium by causing intracellular movement
insulin is sometimes delayed up to 6 hours so that potassium can be rechecked
supplementation increased if needed
Outcomes are worse if insulin therapy is delayed >6 hours
administration
IM q4 hrs
intramuscular (IM) injections or Continuous Rate Infusion (CRI), IV
keep a sampling catheter
blood glucose monitoring (q1‐2 hours)
Dextrose is needed to make this safe at lower BGs.
see sample plans in slides
Regular (short‐acting) insulin
When to switch to an intermediate or long acting SQ insulin?
Rehydrated
Acidosis resolved
Nutritionally supported (eating or feeding tube)
:forbidden: Sodium bicarbonate
can worsen acidosis if patient cannot ventilate
goals
be able to administer insulin frequently
stop ketone production.
Dextrose is needed to make this safe at lower BGs.
Treat/manage concurrent diseases
Other Therapy
Address anorexia and nausea by with anti‐emetics
Appetite stimulants (mirtazapine, capromorelin)
Supportive/symptomatic care
Nutrition
Short‐term feeding tubes (e.g nasogastric)
when patient hasn't eaten for 24-48h
Gastric tubes
when the cause of anorexia is expected to takexlonger to resolve
outcomes
favorable with 70‐95% survival to discharge
Hospitalization is typically 3‐10 days
Prognosis is worse for Hyperosmolar Hyperglycemic State