Management of Diabetic Ketoacidosis (DKA) and Norketotic Hypertoricity (NKH) Diabetic Ketoacidosis Nonketotic Hypertonicity ‘Occurence: Definition Presentation Precipitants ‘Treatment Follow-up Complications ‘Occurs in both type 1 and 2 diabetes Blood glucose >250 ma/at Low bicarbonate (<1'5 mEq/L) Low pH G73) wpe Fatigue, blurred vision, polydipsia, polyuria, weight loss Nautes, vomiting, and tague abdomiial pain are ‘Obtundation, shock, and coma may ensue Russmaut respirations and fruity breath suggest Retoacidoss ‘ aa Infection, omission, oF inadequate use of insulin, new-onset ‘diaberes 1. Hydration Unially a total of 45 needed V Cisotonie saline in first hour, add colloid if hypovolemic Shack present switel td hypotonic saline at 200-1000 mi far once inital fui resusckation complete ‘Add dextrose when glucose 200 ma/a 2. inguin therapy inital priming dose: 0.3-0.4 units/kg “ollowed by infusion at ~7 units/he snirate as nected! ‘Continue until pH and serum bicarbonate normal Bolnet follow serum ketones; as DKA resolves, fe Thydroxybutyrate i Converted to acetoacetate and acetone, 30 ketones appear to be increasing In obtuneied., hyperosmoler patient. lower glucose to 300 and maintain until patient & alert 3. electrolyte replacement. Hypenaternia may be seen initially because of insulin "Geficlency and acidosis, but total body potassium is low After initial iter of normal saline, add 20-30 mea, fanshurn a" KCl and vse EPO.) to cach iter of fiid to cortect hypokalemia and Rypophosphatem's Check glucose once every hour for first several hours then ‘every 4 hr wile on IV fluids cchcgkclectroltes every 2 he until normal, then every 4-6 hr ‘while on IV" ‘check'venous pH to follow resolution of acidosis. Cerebral edema Hyperchloremic acidosis Vatcular thromboembolism regular insulin IV ‘Occurs mainly in type 2 diabetes, but can occur in type 1 1. Effective osmolarity =320 mOsm/L [calculated as 2 (Na + K) 4 (glucesa/18) + (SUN/2-8)], 2, Blood glucose =600 mg/dL 3. paar 1. Fatigue, blurred vision, polysipsia, polyuria, weight lose 2. Severe dehydration 3 Gbtundation, shock, and coma may ensue Infection, new-onset diabetes, stroke, myocardial Infarction, pancrestitis, uremia, burns, subdural ematorna, acromegaly, ectopic ACTH ve geo PPE nt 2 then pr ene 2-3 Hepes to ten ern 8 Si Tren a pi she al nat ei th fe 2 ob trlats beara ter te Nocatee SE mal, 2 Magis RENE GOST 20 so mea once une Apis mott Szaceemt nes ws, » Reb ttey sr are on not pay ier ym eh ac Pepe eam hen nne Shean Check glucose once every hour for frst several hhours, then every 4 hr while on TV fluids check electrolytes every 2hr unt normal, then ‘Svery 4-6 hihi om IV Fluids ‘Vascular thromboembolism, Rhabdomyalyss: ARDS ACTH, adrenocorticotropic hormone; ARDS, acute respwratory distress syndrome; BUN, blood urea nitrogen.