ABC, VS, level of dehydration; Mental status, neuro exam, GCS; Risk for cerebral edema; CR monitor, VS q 15 min, I/O q 1 hr; Start DKA Flow Sheet. IV Access. Diabetic ketoacidosis (DKA) though preventable remains a frequent and life written and accompanied by a practical and easy to follow flow chart to be used in. Diabetic. Ketoacidosis. DKA. Resource Folder. May by Eva Elisabeth Oakes, RN, and Dr. Louise Cole, Senior Staff Specialist.

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Normal or elevated Exp Clin Endocrinol Diabetes.

Management of Diabetic Ketoacidosis – – American Family Physician

No randomized prospective studies have evaluated the optimal site of care for patients with diabetic ketoacidosis. DKA can develop in less than 24 hours. Rosenbloom AL, Hanas R. The main differences in the management of children and adolescents compared with adults are the greater care in administering electrolytes, fluids, and insulin based on the weight of the patient and increased concern flowsheey high fluid rates inducing cerebral edema.

It is observed primarily in people with type one dak insulin dependentbut it can occur in type two diabetes non-insulin dependent under certain circumstances. Patients with an increased alveolar to arterial oxygen gradient AaO2 and patients with pulmonary rales on physical examination may be at increased risk for ARDS.

HHS is more likely in type 2 diabetes, or in type 1 diabetes when the patient has been consuming large quantities of glucose-containing drinks. Handbook of diabetes mellitus. A few studies suggest lfowsheet harms.


The aim is to discharge the patient with sufficient education to prevent re-admission with DKA in the future. The major treatment of this condition is initial rehydration using isotonic saline with subsequent potassium replacement and low-dose insulin therapy. Bicarbonate therapy should not be given to adult patients with a pH level of 7.

In addition to alterations in magnesium metabolism from DKA, many patients with diabetes have taken medications such as diuretics that also may lower magnesium levels. A standard regimen is given in Figure 1. Read the full article. Treatment of suspected cerebral edema should fpowsheet be delayed for these tests to be completed. Diabetic ketoacidosis and hyperosmolar coma.

Because there are no studies on patients with a pH level below 6. Although DKA is less common in these patients than eka those with type 1 diabetes, it does occur.

This is to ensure that the osmolality of the blood does not change too quickly resulting in the rapid movement of fluids from the intravascular space into the interstitial space, leading to one of the biggest complications associated with DKA management: If you have any queries related to the management of DKA in children, please contact the Pediatric Endocrinologist on call. Another important aspect of rehydration therapy in patients with diabetic ketoacidosis is the replacement of ongoing urinary losses.

DKA Protocol

When the blood glucose concentration is approximately mg per dL Patients usually are symptomatic at serum levels of 1. Flowsyeet AE, Rumbak M. During insulin therapy, phosphate reenters the intracellular compartment, leading to mild to moderate reductions in the serum phosphate concentration.


Preventive measures include patient education and instructions for the patient to contact the physician early during an illness.

Managing Diabetic Ketoacidosis: Eight Steps of ACT-RAPID | AUSMED

Hyperglycemic crises in diabetes. Acanthosis nigricans 6 Acromegaly 7 Arterial thrombosis, including mesenteric and iliac 5 Cerebrovascular accident 5 Hemochromatosis 8 Hyperthyroidism 9 Pancreatitis 10 Pregnancy Severely uncontrolled diabetes in the over-fifties. J Am Geriatr Soc. Characteristics of diabetic ketoacidosis in older versus younger adults.

A suggested flow sheet for monitoring response to therapy for diabetic ketoacidosis. Infection, insulin omission, and other problems that may have precipitated ketoacidosis should be treated.

Papilledema, hypertension, hyperpyrexia, and diabetes insipidus also may occur. Myocardial infarction is a precipitating cause of diabetic ketoacidosis that is especially important to look for in older patients flowsheef diabetes. About 10 percent of the patients initially diagnosed with cerebral edema have other intracranial pathology such as subarachnoid hemorrhage.

Treat Potassium Due to the increased level of ketones in the body, there is an increased level of extracellular hydrogen ions acidic which are exchanged for intracellular potassium in an attempt to help the metabolic acidosis improve. DKA patients need to have their airway, breathing and circulation assessed immediately. Due to the lfowsheet diuresis observed in DKA, potassium is then excreted via the urine eventually leading fflowsheet an overall depletion of potassium in both the intravascular and intracellular spaces.