Diabetic Ketoacidosis (DKA)

Rearranged by : Muslim A. AL-mandalawy

4 Criteria for DKA Dx :

•Hyperglycemia
🌸Signs and Symptoms of DKA
•Metabolic acidosis
D: 👉 Diuresis, dehydration, drowsy,
•Hyperketonemia delirium, dizziness

•Ketonuria K: 👉 Kusmaul’s breathing, ketotic breath

A: 👉 Abdominal pain, anorexia

🌸Precipitating Factors in DKA

🙂The 5 Is

👉Infection

👉Ischemia

👉Infarction

👉Intoxication

👉Insulin missed

Management and controls in DKA 🌺

🌸👉• ABCs are first priority

🌸• Monitor degree of ketoacidosis with AG, not BG or serum ketone level

🌸• Rehydration 🌸

👉– 1 L/h NS in first 30 min

👉– 1 L/h NS in first h

👉– 1 L/h NS in second h

👉– after 1st 3 L,….then 1L/ every 2h NS. .. then 1L /every 4 h . then 1L /every 6 h.. then 1L /every 8 h…. Switch to 0.45%
NaCl once euvolemic (continue NS if corrected sodium is falling faster than 3 mosm/kg water/h)

👉– once BG reaches (11mmol/l) or 250 mg/dL then switch to D5W to maintain BG in the range of 12-14 mmol/L
🌸• Insulin therapy🌸

👉-- critical to resolve acidosis, not hyperglycemia

👉– do not use with hypokalemia , until serum K+ is corrected to >3.3 mmol/L

👉– use only regular insulin (R)

👉– maintain on 0.1 U/kg/h insulin R infusion

👉– check serum glucose hourly

🌸• K+ replacement🌸

👉– with insulin administration, hypokalemia may develop

👉– if serum K+<3.5 mmol/L, hold insulin and give 40 mEq/L K+ replacement

👉– when K+ 3.5-5.0 mmol/L add KCL 20 mEq/L IV fluid to keep K+ in the range of 3.5-5 mEq/L

🌸• HCO3–🌸

👉– if pH <7.0 or if hypotension, arrhythmia, or coma is present with a pH of <7.1 give HCO3

👉– in 0.45% NaCl

👉– do not give if pH >7.1 (risk of metabolic alkalosis)

👉– can give in case of life-threatening hyperkalemia

🌸• ± mannitol (for cerebral edema)

😊Summary😊

Treatment of DKA/HHS

👉 • Fluids

👉• Insulin

👉 • Potassium

👉• Search for and treat precipitant