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  • DKA Guideline

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    This document provides guidelines for the management of diabetic ketoacidosis (DKA). It outlines the clinical presentation, diagnosis, initial management, and ongoing care of patients presenting with DKA. The initial management involves fluid resuscitation, intravenous insulin therapy, and monitoring of blood glucose and ketone levels. Ongoing care focuses on correcting electrolyte imbalances and fluid deficits over 48 hours while monitoring for complications. The guidelines provide criteria for resolving DKA and transitioning to subcutaneous insulin therapy.

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    This document provides guidelines for the management of diabetic ketoacidosis (DKA). It outlines the clinical presentation, diagnosis, initial management, and ongoing care of patients presenting with DKA. The initial management involves fluid resuscitation, intravenous insulin therapy, and monitoring of blood glucose and ketone levels. Ongoing care focuses on correcting electrolyte imbalances and fluid deficits over 48 hours while monitoring for complications. The guidelines provide criteria for resolving DKA and transitioning to subcutaneous insulin therapy.

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    © All Rights Reserved
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    3 views1 page

    DKA Guideline

    Uploaded by

    IvonneRemigio
    This document provides guidelines for the management of diabetic ketoacidosis (DKA). It outlines the clinical presentation, diagnosis, initial management, and ongoing care of patients presenting with DKA. The initial management involves fluid resuscitation, intravenous insulin therapy, and monitoring of blood glucose and ketone levels. Ongoing care focuses on correcting electrolyte imbalances and fluid deficits over 48 hours while monitoring for complications. The guidelines provide criteria for resolving DKA and transitioning to subcutaneous insulin therapy.

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    © All Rights Reserved
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    of 1

    BSPED INTERM GUIDELINE 2021

    Algorithm for the Management of


    Diabetic Ketoacidosis

    Clinical History Clinical Signs Biochemistry


    P R E S E N TAT I O N

    • Polyuria • Elevated blood glucose (> 11


    • Assess dehydration mmol/l)
    • Polydipsia
    • Deep sighing respiration • Acidaemia (pH < 7.3)
    • Weight loss
    (Kussmaul)
    • Abdominal pain • Ketones in blood > 3 mmol/L
    • Smell of ketones
    • Weakness • Take blood also for
    • lethargy electrolytes, urea
    • Vomiting
    • drowsiness • Perform other
    • Confusion
    investigations if indicated.

    Confirm Diagnosis

    Call Senior Staff


    DIAGNOSIS

    Check Shock pH < 7.3 = Mild DKA


    (%5 dehydration)
    • ↓ Peripheral pulse
    • ↓ Consciousness
    pH < 7.2 = Mod DKA
    • Coma
    (%7 dehydration)

    pH < 7.1 = Severe DKA


    (%10 dehydration)

    Resusitation
    Resusitation Intravenous Therapy
    INITIAL MANAGEMENT

    • Airway + N/G tube • Give 10ml/kg fluid bolus over 60


    mins.
    • Breathing (100% 02)
    • Circulation (20ml/kg • Calculate fluid requirements —
    0.9% sodium chloride) correct deficit over 48 hours.

    • Repeated 10ml/kg • Use 0.9% sodium chloride with


    boluses until circulation 20 mmol KCl in every 500 ml.
    restored, max 40 ml/kg • Insulin 0.05 or 0.1units/kg/hour
    dose before discussion by infusion 1 – 2 hours after
    with senior doctor). starting IV fluids.

    Observations

    • Hourly: blood glucose,


    ONGOING MANAGEMENT

    neurological status and fluid


    input:output.
    • Electrolytes 2 hours after start
    of IV-therapy, then 4-hourly.
    • 1-2 hourly blood ketone levels

    When glucose < 14


    No Improvement Neurological
    mmol\L
    Detoriation

    • Headache
    Re-evaluate Intravenous Therapy • Irritability.
    • ↓ Heart rate.
    • Fluid balance + IV- • Once blood glucose < 14mmol add
    • ↓ Consciousness.
    therapy. - add 5% glucose to 0.9% sodium
    chloride with 20 mmol KCl per 500 • ↑ ICP.
    • If continued acidosis,
    ml. Reduce insulin infusion to 0.05
    may require further
    units/kg/hr.
    resuscitation fluid.
    • If continuing with 0.1 units/kg/hr - Exclude hypoglycemia
    • Check insulin dose
    add 10% glucose to 0.9% sodium
    correct and running
    chloride with 20 mmol KCl per 500
    properly.
    ml. Cerebral Oedema
    • Consider sepsis.
    • Consider restarting • Give 5 ml/kg 2.7%
    protocol sodium chloride or
    mannitol 0.5 - 1.0 g/kg.
    • Dose may be repeated if
    needed.
    • Call senior staff.
    If blood glucose < 6
    Continue Monitoring • Restrict I.V. fluids by 1/2
    mmol\L
    • Discuss further care
    with paediatric critical
    care specialists.

    Glucose Resolution of DKA

    • Add more glucose to • Clinically well, drinking well,


    0.9% sodium chloride tolerating food .
    • DO not reduce insulin • Blood ketones < 1.0 mmol/l or pH
    below 0.05 units/kg/hr normal.
    if ketones >1 mmol/l.
    • Urine ketones may still be positive.

    Insulin

    • Start subcutaneous insulin then


    stop intravenous insulin 1 hour
    later.

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