Materiały źródłowe

• #1 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. […] Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. […] During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. […] The therapeutic goals of DKA management include optimization of 1) volume status; 2) hyperglycemia and ketoacidosis; 3) electrolyte abnormalities; and 4) potential precipitating factors. […] Several important steps should be followed in the early stages of DKA management: collect blood for metabolic profile before initiation of intravenous fluids; infuse 1 L of 0.9% sodium chloride over 1 hour after drawing initial blood samples; ensure potassium level of 3.3 mEq/L before initiation of insulin therapy (supplement potassium intravenously if needed); initiate insulin therapy only when steps 1-3 are executed.

• #2 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: […] Correction of fluid loss with intravenous fluids […] Correction of hyperglycemia with insulin […] Correction of electrolyte disturbances, particularly potassium loss […] Correction of acid-base balance […] Treatment of concurrent infection, if present. […] It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. […] Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. […] Insulin infusion can be discontinued 30 minutes later.

• #3 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: […] Correction of fluid loss with intravenous fluids […] Correction of hyperglycemia with insulin […] Correction of electrolyte disturbances, particularly potassium loss […] Correction of acid-base balance […] Treatment of concurrent infection, if present. […] It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. […] Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. […] Insulin infusion can be discontinued 30 minutes later.

• #4 Management of Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p455.html

  Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. […] The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. […] The therapeutic goals for diabetic ketoacidosis consist of improving circulatory volume and tissue perfusion, reducing blood glucose and serum osmolality toward normal levels, clearing ketones from serum and urine at a steady rate, correcting electrolyte imbalances and identifying precipitating factors. […] The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.

• #5 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  The protocol for the management of patients with DKA is presented in Figure 1. It must be emphasized that successful treatment requires frequent monitoring of clinical and metabolic parameters that support resolution of DKA. […] Fluid loss averages approximately 6-9 L in DKA. The goal is to replace the total volume loss within 24-36 hours with 50% of resuscitation fluid being administered during the first 8-12 hours. A crystalloid fluid is the initial fluid of choice. […] Insulin administration is essential in DKA treatment because it promotes glucose utilization by peripheral tissues, diminishes glycogenolysis and gluconeogenesis, and suppresses ketogenesis. […] Insulin treatment has evolved from the use of high-dose insulin, with doses up to 100 U/h by various routes of administration, to lower doses in the range of 5-10 U/h.

• #6 Diabetic ketoacidosis – NYSORA

  https://www.nysora.com/anesthesia/diabetic-ketoacidosis/

  Patients with DKA receive emergency treatment in the hospital, including: […] I.v. insulin to lower ketones […] Fluids to prevent dehydration […] Electrolyte replacement: Sodium, potassium, and chloride […] Antibiotics if an infection is also present […] The average fluid deficit in DKA is 6 L […] Start with 500-1500 mL of colloid bolus if clinically hypovolemic […] Initial bolus should be normal saline (NS; 0.9% saline) bolus 10-15 mL/kg […] Change to ½ NS with 20 mEq/L potassium after that […] Replace ongoing intraoperative blood and fluid losses as usually […] Change fluid to D5W with ½ NS if blood sugar drops to 250 mg/dL and anion gap is still present → allows insulin administration to reduce ketone without causing hypoglycemia […] Regular insulin 10 U IV bolus followed with an infusion at (blood glucose/150) U/h

• #7 Review of Diabetic Ketoacidosis Management

  https://www.uspharmacist.com/article/review-of-diabetic-ketoacidosis-management

  The goals of DKA treatment are to normalize fluid-volume status, hyperglycemia, electrolytes, and ketoacidosis. Any other potential precipitating factors should also be identified and addressed. […] In DKA, fluid loss can range from 6 to 9 L. Approximately one-half of the total volume loss should be replaced during the first 8 to 12 hours and the remaining volume within 24 to 36 hours. Rehydration is essential for tissue perfusion and resolution of the associated metabolic abnormalities. […] Volume resuscitation is essential prior to initiating insulin therapy because insulin may worsen dehydration. Prior to initiation of insulin therapy, potassium should be at least 3.3 mEq/L. Insulin promotes the peripheral tissues utilization of glucose by diminishing gluconeogenesis and glycogenolysis and suppressing ketogenesis.

• #8 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin. […] Isotonic fluids have been well established for more than 50 years as preferred fluids. […] Intravenous insulin by continuous infusion is the standard of care. […] Treatment of adult patients who have uncomplicated, mild diabetic ketoacidosis can be treated with subcutaneous insulin lispro hourly in a non-intensive care setting may be safe and cost-effective as opposed to treatment with intravenous regular insulin in the intensive care setting as shown in many studies.

• #9 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  The 2011 JBDS guideline recommends the intravenous infusion of insulin at a weight-based fixed rate until ketosis has subsided. […] In established patients with diabetes, SC long-acting insulin (eg, insulin glargine, Detemir) should be initiated at the dose that was used prior to the manifestation of DKA. […] In newly diagnosed patients with type 1 diabetes, a careful estimate of the long-acting insulin dose should be considered. […] A study by Lakshman et al indicated that in patients with type 1 diabetes, use of a hybrid closed-loop (HCL) system for glycemic control may help to protect against the effects of DKA. […] Fluid resuscitation is a critical part of treating patients with DKA. […] Initial correction of fluid loss is either by isotonic sodium chloride solution or by lactated Ringer solution.

• #10 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin. […] Isotonic fluids have been well established for more than 50 years as preferred fluids. […] Intravenous insulin by continuous infusion is the standard of care. […] Treatment of adult patients who have uncomplicated, mild diabetic ketoacidosis can be treated with subcutaneous insulin lispro hourly in a non-intensive care setting may be safe and cost-effective as opposed to treatment with intravenous regular insulin in the intensive care setting as shown in many studies.

• #11

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  Diabetic Ketoacidosis Treatment […] Initial/Prep/Goals […] 1. ABCs, IV access, O2, monitor frequently […] 2. Goals of acute treatment […] – Correct dehydration, electrolyte imbalance, hyperglycemia […] – Frequent monitoring of patient status […] – Identify comorbid and precipitating factors (see DKA: Overview) […] Medical/Pharmaceutical Algorithms […] 1. Correct Fluid Loss […] – Helps decrease acidosis and hyperglycemia […] – If cardiac compromised (i.e. hypotensive) […] – Rapid infusion with normal/isotonic saline (NS) or Lactated Ringer’s (LR) until SBP 80 mmHg […] – Give 1-2 L NS bolus over 45-60 minutes and repeat until shock corrected […] – If no cardiac compromise […] – NS (0.9% NaCl) infusion at 15-20 mL/kg/hr (or 1-1.5 L during first hour)

• #12 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. […] Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. […] During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. […] The therapeutic goals of DKA management include optimization of 1) volume status; 2) hyperglycemia and ketoacidosis; 3) electrolyte abnormalities; and 4) potential precipitating factors. […] Several important steps should be followed in the early stages of DKA management: collect blood for metabolic profile before initiation of intravenous fluids; infuse 1 L of 0.9% sodium chloride over 1 hour after drawing initial blood samples; ensure potassium level of 3.3 mEq/L before initiation of insulin therapy (supplement potassium intravenously if needed); initiate insulin therapy only when steps 1-3 are executed.

• #13 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  The protocol for the management of patients with DKA is presented in Figure 1. It must be emphasized that successful treatment requires frequent monitoring of clinical and metabolic parameters that support resolution of DKA. […] Fluid loss averages approximately 6-9 L in DKA. The goal is to replace the total volume loss within 24-36 hours with 50% of resuscitation fluid being administered during the first 8-12 hours. A crystalloid fluid is the initial fluid of choice. […] Insulin administration is essential in DKA treatment because it promotes glucose utilization by peripheral tissues, diminishes glycogenolysis and gluconeogenesis, and suppresses ketogenesis. […] Insulin treatment has evolved from the use of high-dose insulin, with doses up to 100 U/h by various routes of administration, to lower doses in the range of 5-10 U/h.

• #14 Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population

  https://www.mdpi.com/2673-396X/3/4/66

  Diabetic ketoacidosis (DKA) requires hospitalization for aggressive fluid replacement, electrolyte management, and insulin therapy. […] Proper management of DKA requires hospitalization for aggressive replacement and monitoring of fluids, electrolytes and insulin therapy. Management of DKA has been updated with guidelines, to help standardize care, and reduce mortality and morbidity. […] Successful treatment of DKA requires correction of dehydration, hyperglycemia and electrolyte imbalances with frequent monitoring of clinical and metabolic parameters that support resolution of DKA. Specific therapeutic goals of DKA management include optimization of (1) volume status; (2) hyperglycemia and ketoacidosis; (3) electrolyte abnormalities; and (4) potential precipitating factors. […] Since DKA patients experience fluid loss of approximately 6–9 L, the goal of fluid resuscitation aims to replete that volume within 24–36 h with 50% of resuscitation fluid administered within first 8–12 h of presentation. Current DKA guidelines recommend initiating volume repletion with isotonic saline (0.9% NaCl) at 15–20 mL/kg/h followed by hypotonic saline solution (0.45% saline) at a rate of 4–14 mL/kg/h then re-evaluate.

• #15 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  When the patient becomes euvolemic, the physician may switch to half the isotonic sodium chloride solution, particularly if hypernatremia exists. […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained. […] Sodium bicarbonate only is infused if decompensated acidosis starts to threaten the patient’s life, especially when associated with either sepsis or lactic acidosis. […] In the presence of infection, the administration of proper antibiotics is guided by the results of culture and sensitivity studies. […] Be extremely cautious to avoid cerebral edema during initiation of therapy. […] Cardiac dysrhythmia may occur secondary to severe hypokalemia and/or acidosis either initially or as a result of therapy in patients with DKA.

• #16 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  The deficit should be replaced as crystalloid. In patients with kidney failure or heart failure, as well as the elderly and adolescents, the rate and volume of fluid replacement may need to be modified. The aim of the first few litres of fluid is to correct any hypotension, replenish the intravascular deficit, and counteract the effects of the osmotic diuresis with correction of the electrolyte disturbance. […] Insulin therapy […] A fixed-rate IV insulin infusion calculated on 0.1 units/per kg body weight/hour is recommended. Insulin has several effects but the most important are the suppression of ketogenesis, reduction of blood glucose and correction of electrolyte disturbance. […] Metabolic treatment targets […] The recommended targets are a reduction of the blood ketone concentration by 0.5 mmol/L/hour, an increase of the venous bicarbonate by 3.0 mmol/L/hour, a reduction of capillary blood glucose by 3.0 mmol/L/hour and to maintain K+ between 4.0 and 5.5 mmol/L. If these rates are not achieved then the insulin infusion rate should be increased.

• #17 Diabetic ketoacidosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555

  If you’re diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: […] Fluids replace those lost through too much urinating. They also thin out the blood sugar. Fluids can be given by mouth or through a vein. When given through a vein, they’re called IV fluids. […] Electrolyte replacement. Electrolytes are minerals in the blood, such as sodium, potassium and chloride, that carry an electric charge. Too little insulin can lower the level of several electrolytes in the blood. IV electrolytes are given to help keep the heart, muscles and nerve cells working as they should. […] Insulin therapy. Insulin reverses diabetic ketoacidosis. In addition to fluids and electrolytes, insulin is given, usually through a vein. A return to regular insulin therapy may be possible when the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic.

• #18 Management of Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p455.html

  Modern management of diabetic ketoacidosis has emphasized the use of lower doses of insulin. This has been shown to be the most efficacious treatment in both children and adults with diabetic ketoacidosis. […] Standard low-dose insulin therapy consists of an initial intravenous bolus of 0.15 unit of regular insulin per kg followed by the continuous intravenous infusion of regular insulin prepared in normal saline or hypotonic saline solution at a rate of 0.1 unit per kg per hour. […] Although the typical potassium deficit in diabetic ketoacidosis is 500 to 700 mEq (500 to 700 mmol), most patients are hyperkalemic at the time of diagnosis because of the effects of insulinopenia, hyperosmolality and acidemia. […] In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy.

• #19

  https://link.springer.com/article/10.1007/s40138-012-0001-3

  The standard is an initial intravenous bolus of regular insulin 0.1 units/kg body weight followed by a continuous infusion of regular insulin at a dose of 0.1 unit/kg/h. […] In mild, uncomplicated cases of DKA a subcutaneous regimen of newer rapid-acting insulin analogues (insulin aspart, lispro, glulisine) have been proposed as safe and effective alternatives to the use of intravenous regular insulin in prospective, randomized trials. […] The following criteria mark the resolution of DKA according to the ADA guidelines: glucose 200 mg/dL, serum bicarbonate 18 mEq/L, serum anion gap 12 mEq/L and a venous pH of 7.3. […] Bicarbonate replacement is a controversial issue and a unified consensus is lacking. […] Proponents of alkali therapy argue severe metabolic acidosis is associated with intracellular acidosis and end organ dysfunction, particularly its deleterious cardiopulmonary effects. […] Once a patient is successfully treated and transitioned to a subcutaneous insulin regimen the focus should turn to prevention of future episodes.

• #20 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  When the patient becomes euvolemic, the physician may switch to half the isotonic sodium chloride solution, particularly if hypernatremia exists. […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained. […] Sodium bicarbonate only is infused if decompensated acidosis starts to threaten the patient’s life, especially when associated with either sepsis or lactic acidosis. […] In the presence of infection, the administration of proper antibiotics is guided by the results of culture and sensitivity studies. […] Be extremely cautious to avoid cerebral edema during initiation of therapy. […] Cardiac dysrhythmia may occur secondary to severe hypokalemia and/or acidosis either initially or as a result of therapy in patients with DKA.

• #21 Diabetic Ketoacidosis (DKA) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

  Treatment of DKA involves volume expansion, insulin replacement, and prevention of hypokalemia. […] The most urgent goals for treating diabetic ketoacidosis are rapid intravascular volume repletion, correction of hyperglycemia and acidosis, and prevention of hypokalemia. […] Intravascular volume should be restored rapidly to raise blood pressure and ensure glomerular perfusion; once intravascular volume is restored, remaining total body water deficits are corrected more slowly, typically over about 24 hours. […] Hyperglycemia is corrected by giving regular insulin 0.1 unit/kg IV bolus initially, followed by continuous IV infusion of 0.1 unit/kg/hour in 0.9% saline solution. […] Insulin should be withheld until serum potassium is 3.3 mEq/L (3.3 mmol/L). […] Prevention of hypokalemia requires replacement of 20 to 30 mEq (20 to 30 mmol) potassium in each liter of IV fluid to keep serum potassium between 4 and 5 mEq/L (4 and 5 mmol/L). […] If bicarbonate is used, it should be started only if the pH is 7, and only modest pH elevation should be attempted with doses of 50 to 100 mEq (50 to 100 mmol) given over 2 hours, followed by repeat measurement of arterial pH and serum potassium.

• #22

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Short half-life, ease of titration […] – Low-dose therapy without bolus preferred […] – Initial bolus controversial […] – May saturate insulin receptors […] – Greater glucose drop in first hr […] – However, in the absence of initial bolus, doses 0.1 units/kg/hr ineffective […] 10. Preferred regimen […] – Low-dose, continuous IV infusion: 0.14 units/kg/hr (no bolus) […] – Anticipate BG drop by 10% in first hour […] – Expect BG decrease rate 50-70 mg/dL/hr […] – If BG drop inadequate ( 10% in first hour or 50 mg/dL/hr) […] – Give 0.14 units/kg IV bolus […] – Then continue with prior infusion rate or increase infusion rate 50-100% (physician discretion) […] – Continue at increased rate until adequate

• #23

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Short half-life, ease of titration […] – Low-dose therapy without bolus preferred […] – Initial bolus controversial […] – May saturate insulin receptors […] – Greater glucose drop in first hr […] – However, in the absence of initial bolus, doses 0.1 units/kg/hr ineffective […] 10. Preferred regimen […] – Low-dose, continuous IV infusion: 0.14 units/kg/hr (no bolus) […] – Anticipate BG drop by 10% in first hour […] – Expect BG decrease rate 50-70 mg/dL/hr […] – If BG drop inadequate ( 10% in first hour or 50 mg/dL/hr) […] – Give 0.14 units/kg IV bolus […] – Then continue with prior infusion rate or increase infusion rate 50-100% (physician discretion) […] – Continue at increased rate until adequate

• #24 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  We recommend an initial bolus of regular insulin of 0.1 U/kg followed by continuous insulin infusion. […] If plasma glucose does not fall by at least 10% in the first hour of insulin infusion rate, 0.1 U/kg bolus of insulin can be given once more while continuing insulin infusion. […] Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. […] Insulin is typically the only treatment necessary for hyperkalemia in dialysis-dependent patients with DKA. […] Serial measurements (every 24 hours) of metabolic parameters are required to monitor therapy and then confirm resolution of DKA. […] When the patient is able to tolerate oral intake and DKA is resolved, transition to subcutaneous insulin must be initiated.

• #25 Diabetic ketoacidosis – WikEM

  https://www.wikem.org/wiki/Diabetic_ketoacidosis

  Do not stop insulin infusion until AG normalized AND bicarb normalized, despite resolution of blood sugar. Aim of insulin regime is to correct the acidosis, not merely the hyperglycemia. […] Insulin Sliding Scale to be started once patient’s DKA has resolved and eating a full diet. […] Avoid intubation unless patient cannot generate respiratory alkalosis compensation due to extreme fatigue. […] Risks associated with intubation in DKA: During sedation/paralysis, a rise in PaCO2 can decrease pH considerably. […] Subsequent hospital discharge requires closing on anion gap and resolution of symptoms.

• #26

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Subsequent choice for fluid replacement dependent on patient status; corrected deficits should be seen in first 24 hours […] – Serum Na+ should be corrected for hyperglycemia […] – For each 100 mg/dL glucose increase above 100 mg/dL, add 1.6 mEq to Na+ value […] – If Na+ normal/elevated: change to 1/2 NS (0.45% NaCl) at 250-500 mL/hr (general rate) […] – If Na+ low: continue with NS (0.9% NaCl) at 250-500 mL/hr (switch to 1/2 NS when sodium normalizes) […] – Keep urine output 1-2 mL/kg/hr […] 2. When BG reaches 200 mg/dL [11.1 mmol/L] and sodium normalizes […] – Add 5% Dextrose in 1/2 NS (0.45% NaCl) at 150-250 mL/hr until DKA resolves […] – *Note*: Hyperglycemia is corrected (6 hrs) before ketoacidosis (12 hrs) […] – Adding 5% Dextrose prevents hypoglycemia as insulin administration continues

• #27 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis. […] Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin. […] Isotonic fluids have been well established for more than 50 years as preferred fluids. […] Intravenous insulin by continuous infusion is the standard of care. […] Treatment of adult patients who have uncomplicated, mild diabetic ketoacidosis can be treated with subcutaneous insulin lispro hourly in a non-intensive care setting may be safe and cost-effective as opposed to treatment with intravenous regular insulin in the intensive care setting as shown in many studies.

• #28 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Intravenous insulin infusions have long been the standard of care for DKA treatment. However, recent guidelines have suggested that subcutaneous insulin can be used to treat mild to moderate DKA effectively. […] Given the significant risks and off-label nature of their use, SGLT-2 inhibitors should only be prescribed for a selected cohort of people with type 1 diabetes under the supervision of a specialist endocrinologist. […] Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter.

• #29 Diabetic ketoacidosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555

  If you’re diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: […] Fluids replace those lost through too much urinating. They also thin out the blood sugar. Fluids can be given by mouth or through a vein. When given through a vein, they’re called IV fluids. […] Electrolyte replacement. Electrolytes are minerals in the blood, such as sodium, potassium and chloride, that carry an electric charge. Too little insulin can lower the level of several electrolytes in the blood. IV electrolytes are given to help keep the heart, muscles and nerve cells working as they should. […] Insulin therapy. Insulin reverses diabetic ketoacidosis. In addition to fluids and electrolytes, insulin is given, usually through a vein. A return to regular insulin therapy may be possible when the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic.

• #30 Management of Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p455.html

  Modern management of diabetic ketoacidosis has emphasized the use of lower doses of insulin. This has been shown to be the most efficacious treatment in both children and adults with diabetic ketoacidosis. […] Standard low-dose insulin therapy consists of an initial intravenous bolus of 0.15 unit of regular insulin per kg followed by the continuous intravenous infusion of regular insulin prepared in normal saline or hypotonic saline solution at a rate of 0.1 unit per kg per hour. […] Although the typical potassium deficit in diabetic ketoacidosis is 500 to 700 mEq (500 to 700 mmol), most patients are hyperkalemic at the time of diagnosis because of the effects of insulinopenia, hyperosmolality and acidemia. […] In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy.

• #31 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  The amount of fluid replaced depends on the estimated degree of dehydration. […] Normal saline (0.9% saline) has generally been the fluid of choice. […] Some guidelines recommend a bolus (initial large dose) of insulin of 0.1 units of insulin per kilogram of body weight. […] In general, insulin is given at 0.1 units/kg per hour to reduce blood sugars and suppress ketone production. […] Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity. […] The administration of sodium bicarbonate solution to rapidly improve the acid levels in the blood is controversial. […] Cerebral edema, if associated with coma, often necessitates admission to intensive care, artificial ventilation, and close observation. […] Resolution of DKA is defined as the general improvement in the symptoms, such as the ability to tolerate oral nutrition and fluids, normalization of blood acidity (pH7.3), and absence of ketones in the blood (1 mmol/L) or urine.

• #32

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  3. Avoid too rapid fluid administration […] – Can cause cerebral edema […] – Rarely seen if 20 years old […] – Occurs in first 24 hrs […] – Unpredictable […] – Headache is first symptom, then neurological deterioration […] – Should prompt head CT or MRI […] – 50% die or have permanent neurological sequelae […] – If cerebral edema does occur, treatment usually with mannitol infusion and mechanical ventilation […] 4. Correct Electrolyte abnormalities […] – Potassium (K+) Correction […] – Establish adequate renal function (i.e. urine output ~50 mL/hr) […] – Hypokalemia must be corrected BEFORE insulin therapy […] – If K+ 3.3 mEq/L […] – Hold insulin […] – Give KCl at 20-40 mEq/hr until K+ 3.3 mEq/L […] – *Note*: KCl at 40 mEq/hr IV is max rate

• #33 Diabetic Ketoacidosis (DKA) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

  Treatment of DKA involves volume expansion, insulin replacement, and prevention of hypokalemia. […] The most urgent goals for treating diabetic ketoacidosis are rapid intravascular volume repletion, correction of hyperglycemia and acidosis, and prevention of hypokalemia. […] Intravascular volume should be restored rapidly to raise blood pressure and ensure glomerular perfusion; once intravascular volume is restored, remaining total body water deficits are corrected more slowly, typically over about 24 hours. […] Hyperglycemia is corrected by giving regular insulin 0.1 unit/kg IV bolus initially, followed by continuous IV infusion of 0.1 unit/kg/hour in 0.9% saline solution. […] Insulin should be withheld until serum potassium is 3.3 mEq/L (3.3 mmol/L). […] Prevention of hypokalemia requires replacement of 20 to 30 mEq (20 to 30 mmol) potassium in each liter of IV fluid to keep serum potassium between 4 and 5 mEq/L (4 and 5 mmol/L). […] If bicarbonate is used, it should be started only if the pH is 7, and only modest pH elevation should be attempted with doses of 50 to 100 mEq (50 to 100 mmol) given over 2 hours, followed by repeat measurement of arterial pH and serum potassium.

• #34

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Oral potassium may be given if required (physician discretion) […] – Requires hourly checks, cardiac monitoring […] – If K+ is 3.3-5.3 mEq/L […] – Give 20-30 mEq K+ in each liter of IV fluid […] – Maintain serum K+ 4-5 mEq/L […] – Check q2h […] – If K+ 5.3 mEq/L […] – DO NOT give K+ […] – Requires monitoring q2h or until serum K+ 5.0 mEq/L […] 5. Sodium Bicarbonate (NaHCO3) […] – Indicated only in life-threatening acidosis […] – If pH 6.9 […] – Use NOT RECOMMENDED […] – If pH is 6.9 […] – Add 100 mEq [100 mmol] bicarbonate + 20 mEq KCl [20 mmol] in 400 mL H2O […] – Infuse at 200 mL/hr over 2 hrs […] – Check bicarbonate and potassium q2h […] – Repeat if necessary until pH 7.0

• #35

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Oral potassium may be given if required (physician discretion) […] – Requires hourly checks, cardiac monitoring […] – If K+ is 3.3-5.3 mEq/L […] – Give 20-30 mEq K+ in each liter of IV fluid […] – Maintain serum K+ 4-5 mEq/L […] – Check q2h […] – If K+ 5.3 mEq/L […] – DO NOT give K+ […] – Requires monitoring q2h or until serum K+ 5.0 mEq/L […] 5. Sodium Bicarbonate (NaHCO3) […] – Indicated only in life-threatening acidosis […] – If pH 6.9 […] – Use NOT RECOMMENDED […] – If pH is 6.9 […] – Add 100 mEq [100 mmol] bicarbonate + 20 mEq KCl [20 mmol] in 400 mL H2O […] – Infuse at 200 mL/hr over 2 hrs […] – Check bicarbonate and potassium q2h […] – Repeat if necessary until pH 7.0

• #36

  https://www.vin.com/apputil/content/defaultadv1.aspx?id=8249936&pid=19840&

  Patients with hypokalemia require potassium supplementation, and use of potassium CRI is commonly employed with values less than 3.2 mmol/L. Rate of administration generally should not exceed 0.5 mEq/ kg/hr, and appropriate cardiovascular monitoring (e.g.: electrocardiography/telemetry) is recommended. A lack of improvement in serum potassium levels despite apparently adequate supplementation should raise concern for concurrent hypomagnesemia. Clinical signs of hypomagnesemia are usually not seen unless ionized magnesium is less than 0.41 mmol/L. Supplementation is indicated in cases of refractory hypokalemia, certain ventricular dysrhythmias, and/or patients with persistent lethargy, hyporexia/anorexia, and/or weakness. Phosphorous may rapidly decrease due to translocation into the cell associated with insulin administration, and dilution, as well as renal and/or gastrointestinal loss. Replacement of phosphorous should occur if levels are less than 0.48 mmol/L (1.5 mg/dl).

• #37 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Patients with DKA should be treated with insulin until resolution. […] Electrolyte Replacement […] Patients with DKA are often found to initially have mild to moderate hyperkalemia, despite a total body deficit of potassium. […] Bicarbonate replacement does not appear to be beneficial. […] The role of phosphate replacement in DKA has been looked at in different studies. […] Mental status and neurologic exam should be monitored in all patients with DKA. […] Infection is a very common trigger for DKA in patients who have new-onset diabetes and previously established diabetes.

• #38 Management of Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p455.html

  Modern management of diabetic ketoacidosis has emphasized the use of lower doses of insulin. This has been shown to be the most efficacious treatment in both children and adults with diabetic ketoacidosis. […] Standard low-dose insulin therapy consists of an initial intravenous bolus of 0.15 unit of regular insulin per kg followed by the continuous intravenous infusion of regular insulin prepared in normal saline or hypotonic saline solution at a rate of 0.1 unit per kg per hour. […] Although the typical potassium deficit in diabetic ketoacidosis is 500 to 700 mEq (500 to 700 mmol), most patients are hyperkalemic at the time of diagnosis because of the effects of insulinopenia, hyperosmolality and acidemia. […] In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy.

• #39

  https://www.vin.com/apputil/content/defaultadv1.aspx?id=8249936&pid=19840&

  The use of sodium bicarbonate is controversial, as correction of acidosis is usually accomplished with intravenous fluids and insulin. Detrimental effects include hypocalcemia, hypokalemia, decreased DO2, paradoxical central nervous system acidosis, and prolongation of ketone metabolism. Supplementation should be considered with serum bicarbonate levels lower than 8 mmol/L, pH less than 7.1, and clinical signs of metabolic acidosis.

• #40

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  6. Sodium […] – Usually corrected by fluid resuscitation […] 7. Phosphate […] – Not usually needed except in severe deficiency with comorbid conditions (physician discretion) […] – Indicated only to prevent muscle weakness if cardiac dysfunction, anemia, or respiratory depression present […] – If phosphate 1.0 […] – Add 20-30 mEq/L potassium phosphate (K2PO4) at 1.5 mL/hr (4.5 mmol/hr of K2PO4) […] – *Note*: Replace fraction of potassium with K2PO4 […] – K2PO4: replace 1/3 potassium […] – KCl: replace 2/3 potassium […] 8. Magnesium […] – If Mg2+ 1.2 mg/dL and symptomatic […] – Add 1-2 g of MgSO4 IM or IV over 1 hr […] 9. Insulin Therapy […] – Make sure K+ is 3.3 mEq/L [3.3 mmol/L] […] – ADA preferred route of administration is continuous IV infusion of low-dose regular insulin

• #41 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  Insulin therapy should be initiated only after the serum potassium level is at least 3.3 mmol/L and hypokalemia has been resolved. […] There are 2 ways to administer intravenous (IV) insulin: as an initial bolus of 0.1 units/kg of IV regular insulin followed by an hourly infusion of 0.1 units/kg; or as a continuous infusion of 0.14 units/kg per hour without the bolus. […] If serum potassium is less than 3.3 mmol/L at presentation, 20 to 30 mmol of potassium chloride should be infused with each liter of IV fluid to achieve and maintain a potassium level of 4 to 5 mmol/L. […] In general, bicarbonate therapy isn’t recommended for treating patients with DKA because it hasn’t been proven to reduce the length of time to resolution of DKA and discharge, and may extend the hospital length of stay.

• #42 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  When the patient becomes euvolemic, the physician may switch to half the isotonic sodium chloride solution, particularly if hypernatremia exists. […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained. […] Sodium bicarbonate only is infused if decompensated acidosis starts to threaten the patient’s life, especially when associated with either sepsis or lactic acidosis. […] In the presence of infection, the administration of proper antibiotics is guided by the results of culture and sensitivity studies. […] Be extremely cautious to avoid cerebral edema during initiation of therapy. […] Cardiac dysrhythmia may occur secondary to severe hypokalemia and/or acidosis either initially or as a result of therapy in patients with DKA.

• #43 Diabetic Ketoacidosis (DKA) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

  Treatment of DKA involves volume expansion, insulin replacement, and prevention of hypokalemia. […] The most urgent goals for treating diabetic ketoacidosis are rapid intravascular volume repletion, correction of hyperglycemia and acidosis, and prevention of hypokalemia. […] Intravascular volume should be restored rapidly to raise blood pressure and ensure glomerular perfusion; once intravascular volume is restored, remaining total body water deficits are corrected more slowly, typically over about 24 hours. […] Hyperglycemia is corrected by giving regular insulin 0.1 unit/kg IV bolus initially, followed by continuous IV infusion of 0.1 unit/kg/hour in 0.9% saline solution. […] Insulin should be withheld until serum potassium is 3.3 mEq/L (3.3 mmol/L). […] Prevention of hypokalemia requires replacement of 20 to 30 mEq (20 to 30 mmol) potassium in each liter of IV fluid to keep serum potassium between 4 and 5 mEq/L (4 and 5 mmol/L). […] If bicarbonate is used, it should be started only if the pH is 7, and only modest pH elevation should be attempted with doses of 50 to 100 mEq (50 to 100 mmol) given over 2 hours, followed by repeat measurement of arterial pH and serum potassium.

• #44 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Patients with DKA should be treated with insulin until resolution. […] Electrolyte Replacement […] Patients with DKA are often found to initially have mild to moderate hyperkalemia, despite a total body deficit of potassium. […] Bicarbonate replacement does not appear to be beneficial. […] The role of phosphate replacement in DKA has been looked at in different studies. […] Mental status and neurologic exam should be monitored in all patients with DKA. […] Infection is a very common trigger for DKA in patients who have new-onset diabetes and previously established diabetes.

• #45

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  6. Sodium […] – Usually corrected by fluid resuscitation […] 7. Phosphate […] – Not usually needed except in severe deficiency with comorbid conditions (physician discretion) […] – Indicated only to prevent muscle weakness if cardiac dysfunction, anemia, or respiratory depression present […] – If phosphate 1.0 […] – Add 20-30 mEq/L potassium phosphate (K2PO4) at 1.5 mL/hr (4.5 mmol/hr of K2PO4) […] – *Note*: Replace fraction of potassium with K2PO4 […] – K2PO4: replace 1/3 potassium […] – KCl: replace 2/3 potassium […] 8. Magnesium […] – If Mg2+ 1.2 mg/dL and symptomatic […] – Add 1-2 g of MgSO4 IM or IV over 1 hr […] 9. Insulin Therapy […] – Make sure K+ is 3.3 mEq/L [3.3 mmol/L] […] – ADA preferred route of administration is continuous IV infusion of low-dose regular insulin

• #46

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  6. Sodium […] – Usually corrected by fluid resuscitation […] 7. Phosphate […] – Not usually needed except in severe deficiency with comorbid conditions (physician discretion) […] – Indicated only to prevent muscle weakness if cardiac dysfunction, anemia, or respiratory depression present […] – If phosphate 1.0 […] – Add 20-30 mEq/L potassium phosphate (K2PO4) at 1.5 mL/hr (4.5 mmol/hr of K2PO4) […] – *Note*: Replace fraction of potassium with K2PO4 […] – K2PO4: replace 1/3 potassium […] – KCl: replace 2/3 potassium […] 8. Magnesium […] – If Mg2+ 1.2 mg/dL and symptomatic […] – Add 1-2 g of MgSO4 IM or IV over 1 hr […] 9. Insulin Therapy […] – Make sure K+ is 3.3 mEq/L [3.3 mmol/L] […] – ADA preferred route of administration is continuous IV infusion of low-dose regular insulin

• #47

  https://www.vin.com/apputil/content/defaultadv1.aspx?id=8249936&pid=19840&

  Patients with hypokalemia require potassium supplementation, and use of potassium CRI is commonly employed with values less than 3.2 mmol/L. Rate of administration generally should not exceed 0.5 mEq/ kg/hr, and appropriate cardiovascular monitoring (e.g.: electrocardiography/telemetry) is recommended. A lack of improvement in serum potassium levels despite apparently adequate supplementation should raise concern for concurrent hypomagnesemia. Clinical signs of hypomagnesemia are usually not seen unless ionized magnesium is less than 0.41 mmol/L. Supplementation is indicated in cases of refractory hypokalemia, certain ventricular dysrhythmias, and/or patients with persistent lethargy, hyporexia/anorexia, and/or weakness. Phosphorous may rapidly decrease due to translocation into the cell associated with insulin administration, and dilution, as well as renal and/or gastrointestinal loss. Replacement of phosphorous should occur if levels are less than 0.48 mmol/L (1.5 mg/dl).

• #48

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  6. Sodium […] – Usually corrected by fluid resuscitation […] 7. Phosphate […] – Not usually needed except in severe deficiency with comorbid conditions (physician discretion) […] – Indicated only to prevent muscle weakness if cardiac dysfunction, anemia, or respiratory depression present […] – If phosphate 1.0 […] – Add 20-30 mEq/L potassium phosphate (K2PO4) at 1.5 mL/hr (4.5 mmol/hr of K2PO4) […] – *Note*: Replace fraction of potassium with K2PO4 […] – K2PO4: replace 1/3 potassium […] – KCl: replace 2/3 potassium […] 8. Magnesium […] – If Mg2+ 1.2 mg/dL and symptomatic […] – Add 1-2 g of MgSO4 IM or IV over 1 hr […] 9. Insulin Therapy […] – Make sure K+ is 3.3 mEq/L [3.3 mmol/L] […] – ADA preferred route of administration is continuous IV infusion of low-dose regular insulin

• #49 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. Your treatment will likely include: […] Receiving insulin. Insulin reverses the conditions that cause DKA. […] Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. […] Replacing electrolytes (minerals in your body). Too little insulin can lower electrolytes. […] Taking medicines for any underlying illness that caused DKA, such as antibiotics for an infection.

• #50 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. Your treatment will likely include: […] Receiving insulin. Insulin reverses the conditions that cause DKA. […] Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. […] Replacing electrolytes (minerals in your body). Too little insulin can lower electrolytes. […] Taking medicines for any underlying illness that caused DKA, such as antibiotics for an infection.

• #51 Diabetic Ketoacidosis

  https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/

  Overall, infective precipitants are uncommon. […] In children with known T1DM the most common cause of DKA is omission or significant reduction in recent insulin doses. […] If the acidosis is not correcting, consider the following: […] Insufficient insulin to switch off ketosis (check insulin delivery) […] Inadequate rehydration […] Sepsis […] Hyperchloraemic acidosis (secondary to IV fluids) […] Sodium bicarbonate dose (mmol) = 0.15 x body weight (kg) x base deficit (mmol/L) […] Administer IV over 30-60 minutes with cardiac monitoring.

• #52 Diabetic Ketoacidosis • LITFL • CCC Endocrine

  https://litfl.com/diabetic-ketoacidosis/

  start insulin infusion (avoid bolus) 0.1u/kg/hr […] aim to lower glucose by 1-2mmol/L/hr […] balanced salt solution fluid resuscitation […] once glucose 15mmol/L – provide dextrose (5%) 100mL/hr […] monitor urinary ketones or BE clearance […] correct osmolality by 3mosmol/kg/hr […] Underlying cause […] treat infection […] review compliance […] ischaemia (ACS, CVA, PVD, mesenteric ischaemia) […] pregnancy

• #53

  https://myhealth.alberta.ca/Learning/insulin-pump-therapy/DKA

  Diabetic ketoacidosis (also called DKA for short) is a problem that can happen because of diabetes. DKA happens when there isnt enough insulin in your body. Too little insulin leads to a buildup of acids, called ketones, in your blood. DKA can cause death. […] But people on insulin pumps have a much higher risk. […] If their infusion stops and they dont know, or they miss a bolus, they can have dangerously high blood glucose or DKA in just 2 to 4 hours. […] There are a few reasons why the insulin pump might stop giving insulin and cause DKA: The infusion site (where the cannula goes into your skin) has been used for too long, is irritated, or infected. The cannula or tubing has a bad connection, kink, or leak. The pump stops working properly or a part breaks. The pump programming isnt working properly.

• #54 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  When the patient becomes euvolemic, the physician may switch to half the isotonic sodium chloride solution, particularly if hypernatremia exists. […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained. […] Sodium bicarbonate only is infused if decompensated acidosis starts to threaten the patient’s life, especially when associated with either sepsis or lactic acidosis. […] In the presence of infection, the administration of proper antibiotics is guided by the results of culture and sensitivity studies. […] Be extremely cautious to avoid cerebral edema during initiation of therapy. […] Cardiac dysrhythmia may occur secondary to severe hypokalemia and/or acidosis either initially or as a result of therapy in patients with DKA.

• #55 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  The protocol for the management of patients with DKA is presented in Figure 1. It must be emphasized that successful treatment requires frequent monitoring of clinical and metabolic parameters that support resolution of DKA. […] Fluid loss averages approximately 6-9 L in DKA. The goal is to replace the total volume loss within 24-36 hours with 50% of resuscitation fluid being administered during the first 8-12 hours. A crystalloid fluid is the initial fluid of choice. […] Insulin administration is essential in DKA treatment because it promotes glucose utilization by peripheral tissues, diminishes glycogenolysis and gluconeogenesis, and suppresses ketogenesis. […] Insulin treatment has evolved from the use of high-dose insulin, with doses up to 100 U/h by various routes of administration, to lower doses in the range of 5-10 U/h.

• #56 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Patients should ideally be managed in an HDU type of setting, or even ITU if they are severely unwell. […] […] Electrolytes and venous bicarbonate must be checked at least every 1-2 hours for the first 2-4 hours and then 2- to 4-hourly thereafter (frequency will depend upon the individual clinical scenario). […] […] Monitor hourly fluid balance. […] […] Monitor capillary blood glucose every hour with an aim to reduce plasma glucose by 3-5 mmol/L/hour. […] […] Plasma glucose should also be checked regularly, as capillary blood glucose may be inaccurate in DKA. […] […] If capillary/plasma glucose has not fallen by at least 4 mmol/L in the first hour then check adequacy of rehydration and patency of infusion lines; if these are not at fault then double the dose of insulin for the next hour. […] […] When plasma glucose is 12 mmol/L then replace normal saline with 5% dextrose to prevent over-rapid correction of blood glucose and hypoglycaemia.

• #57 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Patients should ideally be managed in an HDU type of setting, or even ITU if they are severely unwell. […] […] Electrolytes and venous bicarbonate must be checked at least every 1-2 hours for the first 2-4 hours and then 2- to 4-hourly thereafter (frequency will depend upon the individual clinical scenario). […] […] Monitor hourly fluid balance. […] […] Monitor capillary blood glucose every hour with an aim to reduce plasma glucose by 3-5 mmol/L/hour. […] […] Plasma glucose should also be checked regularly, as capillary blood glucose may be inaccurate in DKA. […] […] If capillary/plasma glucose has not fallen by at least 4 mmol/L in the first hour then check adequacy of rehydration and patency of infusion lines; if these are not at fault then double the dose of insulin for the next hour. […] […] When plasma glucose is 12 mmol/L then replace normal saline with 5% dextrose to prevent over-rapid correction of blood glucose and hypoglycaemia.

• #58 Diabetic Ketoacidosis (DKA) – EMCrit Project

  https://emcrit.org/ibcc/dka/

  NAGMA should be treated with IV bicarbonate to achieve a bicarbonate level 18-20 mEq/L before discontinuing the insulin infusion. […] Restart the insulin infusion. […] The primary problem with DKA is ketoacidosis (not hyperglycemia). Therefore, our overall goal is to titrate insulin as needed to treat the ketoacidosis. […] Long-acting insulin should be started early (well in advance of discontinuing the infusion). […] Avoid aggressive volume administration. […] For euvolemic patients, D10W may be superior to D5W to avoid causing hyponatremia. […] If beta-hydroxybutyrate is available, this is arguably the best way to determine the severity of the ketoacidosis. […] Treatment overall is very similar to DKA in general, with a few nuances: Aggressive IV dextrose must be started immediately.

• #59 DKA – Adults

  https://emed.ie/Metabolic/DKA_Adult.php

  Relative insulin deficiency = Glu, pH and ketonaemia. […] 1. Replace lost fluid electrolytes […] 2. Correction of ketoacidosis […] Insulin suppression of ketogenesis […] Insulin stimulated entry of glucose into cells (correct ketonaemia) […] To achieve this you need to give enough insulin to correct the acidosis. Once the blood glucose falls you will often need to support the insulin with infused dextrose […] 3. Slow correct hyperglycaemia […] aim for glucose fall 3-5 mmol/l/hr only […] allow acidosis to correct as above […] No bicarb. unless pH 6.9 If necessary use IL 1.26% solution + 20 mmol KCl […] 4. Treat cause […] Start infusion at 0.1U/Kg/hour […] For patients on basal bolus insulin (e.g. Glargine, Detemir) it should be continued where possible. […] Monitor intake/output

• #60 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Treat any precipitating illness […] Measures to actively detect a precipitating cause should be pursued. […] […] One clue to the possibility of an unrecognised underlying cause is if the pH and anion gap fail to improve despite the aforementioned measures. In this case, review insulin therapy and consider other further investigations – eg, serial ECGs in silent cardiac ischaemia. […] […] If an underlying cause is identified then it should also be treated, as appropriate. […] […] If there are reasonable clinical grounds to suspect infection as the precipitant then appropriate antibiotic therapy should be given (usually broad-spectrum blind treatment); routine antibiotics are not advised. […] Monitoring diabetic ketoacidosis […] To reduce the risk of catastrophic outcomes in adults with DKA, ensure that monitoring is continuous and that review covers all aspects of clinical management at frequent intervals.

• #61 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Patients with DKA should be treated with insulin until resolution. […] Electrolyte Replacement […] Patients with DKA are often found to initially have mild to moderate hyperkalemia, despite a total body deficit of potassium. […] Bicarbonate replacement does not appear to be beneficial. […] The role of phosphate replacement in DKA has been looked at in different studies. […] Mental status and neurologic exam should be monitored in all patients with DKA. […] Infection is a very common trigger for DKA in patients who have new-onset diabetes and previously established diabetes.

• #62

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Evidence is accumulating to utilize point-of-care -OHB determinations 1 mmol/L (2 occasions) as indicator of recovery […] – Occurs significantly earlier than urine ketone clearance […] – DKA is considered resolved when […] 1. Blood glucose is 11.1 mmol/L […] 2. Serum bicarbonate 18 mmol/L OR venous pH 7.3 […] 3. Note that clearance of serum or urine ketones takes longer to resolve than blood glucose and pH

• #63

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Evidence is accumulating to utilize point-of-care -OHB determinations 1 mmol/L (2 occasions) as indicator of recovery […] – Occurs significantly earlier than urine ketone clearance […] – DKA is considered resolved when […] 1. Blood glucose is 11.1 mmol/L […] 2. Serum bicarbonate 18 mmol/L OR venous pH 7.3 […] 3. Note that clearance of serum or urine ketones takes longer to resolve than blood glucose and pH

• #64 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  However, bicarbonate therapy may be considered in adults in shock or in cases of severe metabolic acidosis to mitigate adverse cardiac effects such as decreased contractility and cerebral vasodilation. […] Although serum phosphate levels decrease in response to insulin, phosphate replacement is not recommended as a routine treatment for DKA. […] Diabetic ketoacidosis can be considered resolved when a patient has a blood glucose level 200 mg/dL and at least 2 of the following: Serum bicarbonate level greater than 15 mmol/L; Venous pH greater than 7.3; and Anion gap (calculated) less than or equal to 12 mmol/L.

• #65 Diabetic Ketoacidosis (DKA) – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/ddi/diabetic-ketoacidosis-dka/

  However, bicarbonate therapy may be considered in adults in shock or in cases of severe metabolic acidosis to mitigate adverse cardiac effects such as decreased contractility and cerebral vasodilation. […] Although serum phosphate levels decrease in response to insulin, phosphate replacement is not recommended as a routine treatment for DKA. […] Diabetic ketoacidosis can be considered resolved when a patient has a blood glucose level 200 mg/dL and at least 2 of the following: Serum bicarbonate level greater than 15 mmol/L; Venous pH greater than 7.3; and Anion gap (calculated) less than or equal to 12 mmol/L.

• #66 Diabetic ketoacidosis in adults: identification, diagnosis and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/diabetic-ketoacidosis-in-adults-identification-diagnosis-and-management

  FRII should be continued until ketones are less than 0.6 mmol/L and venous pH is over 7.3. […] Re-establishing a person’s usual insulin regimen or initiating a long-term insulin regimen in those newly diagnosed, is usually done by the diabetes specialist team. […] Managing a patient’s long-term subcutaneous insulin is an important role for the pharmacist in the management of DKA.

• #67 Management of Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p455.html

  When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started. […] Symptomatic cerebral edema occurs primarily in pediatric patients, particularly those with newly diagnosed diabetes. […] With the use of standardized written treatment guidelines and flow sheets for monitoring therapeutic response, the mortality rate for patients with diabetic ketoacidosis is now less than 5 percent.

• #68 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  The 2011 JBDS guideline recommends the intravenous infusion of insulin at a weight-based fixed rate until ketosis has subsided. […] In established patients with diabetes, SC long-acting insulin (eg, insulin glargine, Detemir) should be initiated at the dose that was used prior to the manifestation of DKA. […] In newly diagnosed patients with type 1 diabetes, a careful estimate of the long-acting insulin dose should be considered. […] A study by Lakshman et al indicated that in patients with type 1 diabetes, use of a hybrid closed-loop (HCL) system for glycemic control may help to protect against the effects of DKA. […] Fluid resuscitation is a critical part of treating patients with DKA. […] Initial correction of fluid loss is either by isotonic sodium chloride solution or by lactated Ringer solution.

• #69 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  The regimen containing both long-acting and short-acting insulin is called a basal-bolus insulin regimen; it provides physiological replacement of insulin. […] Safe strategies to restore volume deficit and replace insulin should be implemented, with frequent evaluations of the patients status aimed at monitoring for DKA resolution and avoiding potential complications.

• #70 Management of adult diabetic ketoacidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4085289/

  We recommend an initial bolus of regular insulin of 0.1 U/kg followed by continuous insulin infusion. […] If plasma glucose does not fall by at least 10% in the first hour of insulin infusion rate, 0.1 U/kg bolus of insulin can be given once more while continuing insulin infusion. […] Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. […] Insulin is typically the only treatment necessary for hyperkalemia in dialysis-dependent patients with DKA. […] Serial measurements (every 24 hours) of metabolic parameters are required to monitor therapy and then confirm resolution of DKA. […] When the patient is able to tolerate oral intake and DKA is resolved, transition to subcutaneous insulin must be initiated.

• #71 DKA – Adults

  https://emed.ie/Metabolic/DKA_Adult.php

  Hourly glucose monitoring. Aim for drop 4-5mmol/L/hr. Avoid rapid reduction. […] Do not use bicarbonate without prior discussion with EM senior/endocrine agreement […] SC insulin should be resumed after the patient is euglycaemic, ketone free and eating/drinking normally. Allow 30 minute overlap after 1st injection of rapid-acting insulin before the insulin infusion is stopped […] Reinforce diabetes education re DKA prevention / sick day rules prior to discharge.

• #72 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment. […] Treatment complications include: […] To avoid this, potassium and other minerals are usually given with fluid replacement as part of the treatment of diabetic ketoacidosis. […] If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care.

• #73 Diabetic ketoacidosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/162

  Diabetic ketoacidosis (DKA) is characterised by a biochemical triad of hyperglycaemia (or a history of diabetes), ketonaemia, and metabolic acidosis, with rapid symptom onset. […] Successful treatment includes correction of volume depletion, ketogenesis, hyperglycaemia, electrolyte imbalances, and comorbid precipitating events, with frequent monitoring. […] DKA is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. […] Cerebral oedema, a rare but potentially rapidly fatal complication, occurs mainly in children. It may be prevented by avoiding overly rapid fluid and electrolyte replacement.

• #74

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  3. Avoid too rapid fluid administration […] – Can cause cerebral edema […] – Rarely seen if 20 years old […] – Occurs in first 24 hrs […] – Unpredictable […] – Headache is first symptom, then neurological deterioration […] – Should prompt head CT or MRI […] – 50% die or have permanent neurological sequelae […] – If cerebral edema does occur, treatment usually with mannitol infusion and mechanical ventilation […] 4. Correct Electrolyte abnormalities […] – Potassium (K+) Correction […] – Establish adequate renal function (i.e. urine output ~50 mL/hr) […] – Hypokalemia must be corrected BEFORE insulin therapy […] – If K+ 3.3 mEq/L […] – Hold insulin […] – Give KCl at 20-40 mEq/hr until K+ 3.3 mEq/L […] – *Note*: KCl at 40 mEq/hr IV is max rate

• #75 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Patients should ideally be managed in an HDU type of setting, or even ITU if they are severely unwell. […] […] Electrolytes and venous bicarbonate must be checked at least every 1-2 hours for the first 2-4 hours and then 2- to 4-hourly thereafter (frequency will depend upon the individual clinical scenario). […] […] Monitor hourly fluid balance. […] […] Monitor capillary blood glucose every hour with an aim to reduce plasma glucose by 3-5 mmol/L/hour. […] […] Plasma glucose should also be checked regularly, as capillary blood glucose may be inaccurate in DKA. […] […] If capillary/plasma glucose has not fallen by at least 4 mmol/L in the first hour then check adequacy of rehydration and patency of infusion lines; if these are not at fault then double the dose of insulin for the next hour. […] […] When plasma glucose is 12 mmol/L then replace normal saline with 5% dextrose to prevent over-rapid correction of blood glucose and hypoglycaemia.

• #76

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  3. Avoid too rapid fluid administration […] – Can cause cerebral edema […] – Rarely seen if 20 years old […] – Occurs in first 24 hrs […] – Unpredictable […] – Headache is first symptom, then neurological deterioration […] – Should prompt head CT or MRI […] – 50% die or have permanent neurological sequelae […] – If cerebral edema does occur, treatment usually with mannitol infusion and mechanical ventilation […] 4. Correct Electrolyte abnormalities […] – Potassium (K+) Correction […] – Establish adequate renal function (i.e. urine output ~50 mL/hr) […] – Hypokalemia must be corrected BEFORE insulin therapy […] – If K+ 3.3 mEq/L […] – Hold insulin […] – Give KCl at 20-40 mEq/hr until K+ 3.3 mEq/L […] – *Note*: KCl at 40 mEq/hr IV is max rate

• #77

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  3. Avoid too rapid fluid administration […] – Can cause cerebral edema […] – Rarely seen if 20 years old […] – Occurs in first 24 hrs […] – Unpredictable […] – Headache is first symptom, then neurological deterioration […] – Should prompt head CT or MRI […] – 50% die or have permanent neurological sequelae […] – If cerebral edema does occur, treatment usually with mannitol infusion and mechanical ventilation […] 4. Correct Electrolyte abnormalities […] – Potassium (K+) Correction […] – Establish adequate renal function (i.e. urine output ~50 mL/hr) […] – Hypokalemia must be corrected BEFORE insulin therapy […] – If K+ 3.3 mEq/L […] – Hold insulin […] – Give KCl at 20-40 mEq/hr until K+ 3.3 mEq/L […] – *Note*: KCl at 40 mEq/hr IV is max rate

• #78

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Subsequent choice for fluid replacement dependent on patient status; corrected deficits should be seen in first 24 hours […] – Serum Na+ should be corrected for hyperglycemia […] – For each 100 mg/dL glucose increase above 100 mg/dL, add 1.6 mEq to Na+ value […] – If Na+ normal/elevated: change to 1/2 NS (0.45% NaCl) at 250-500 mL/hr (general rate) […] – If Na+ low: continue with NS (0.9% NaCl) at 250-500 mL/hr (switch to 1/2 NS when sodium normalizes) […] – Keep urine output 1-2 mL/kg/hr […] 2. When BG reaches 200 mg/dL [11.1 mmol/L] and sodium normalizes […] – Add 5% Dextrose in 1/2 NS (0.45% NaCl) at 150-250 mL/hr until DKA resolves […] – *Note*: Hyperglycemia is corrected (6 hrs) before ketoacidosis (12 hrs) […] – Adding 5% Dextrose prevents hypoglycemia as insulin administration continues

• #79

  https://www.pepidconnect.com/Default.aspx?new=2&accessCode=Diabetic%20Ketoacidosis%20Treatment

  – Ensures adequate plasma insulin levels […] – Maintain BG 150-200 mg/dL [8.3-11.1 mmol/L] until resolution of DKA […] 13. Start standard insulin therapy when DKA is resolved […] 14. Monitoring […] – Morbidity in DKA is often iatrogenic […] – Hypokalemia from not replacing K+ […] – CHF from over-aggressive fluid resuscitation […] – Rarely, cerebral edema […] – Hypoglycemia from not monitoring glucose levels […] – Alkalosis from too much HCO3- […] – Meticulous flow sheets for […] – VS, IO, Insulin given […] – Electrolytes […] – K+ (hourly) […] – Cl- […] – HCO3-, pH, CO2 […] – Indicators of recovery in most institutions are […] – pH 7.3 and urine ketone-free

• #80 Diabetic ketoacidosis – NYSORA

  https://www.nysora.com/anesthesia/diabetic-ketoacidosis/

  Do not stop insulin if glucose <90, rather increase i.v. glucose administration [...] Consider changing to SQ insulin when the patient resumes P.O. alimentation [...] Follow electrolytes closely every 4-6 h (every 2 h at the very beginning) until the anion gap closed [...] Potassium: 10-15 mEq/h for at least the first 4 h [...] Irrespective of the initial potassium level, for a goal of 4–5 mEq/L [...] Potassium will shift back to the intracellular compartment because of insulin and lead to hypokalemia if uncorrected [...] Administer bicarbonate only if pH <7.0 or hemodynamic instability (rare) [...] Consider thromboprophylaxis depending on the risk [...] Manage diabetes [...] Monitor blood sugar levels [...] Adjust the insulin dose as needed [...] Check the ketone level [...] Be prepared to act quickly

• #81 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  Patients should ideally be managed in an HDU type of setting, or even ITU if they are severely unwell. […] […] Electrolytes and venous bicarbonate must be checked at least every 1-2 hours for the first 2-4 hours and then 2- to 4-hourly thereafter (frequency will depend upon the individual clinical scenario). […] […] Monitor hourly fluid balance. […] […] Monitor capillary blood glucose every hour with an aim to reduce plasma glucose by 3-5 mmol/L/hour. […] […] Plasma glucose should also be checked regularly, as capillary blood glucose may be inaccurate in DKA. […] […] If capillary/plasma glucose has not fallen by at least 4 mmol/L in the first hour then check adequacy of rehydration and patency of infusion lines; if these are not at fault then double the dose of insulin for the next hour. […] […] When plasma glucose is 12 mmol/L then replace normal saline with 5% dextrose to prevent over-rapid correction of blood glucose and hypoglycaemia.

• #82 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment. […] Treatment complications include: […] To avoid this, potassium and other minerals are usually given with fluid replacement as part of the treatment of diabetic ketoacidosis. […] If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care.

• #83 Diabetic Ketoacidosis (DKA) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka

  Treatment of DKA involves volume expansion, insulin replacement, and prevention of hypokalemia. […] The most urgent goals for treating diabetic ketoacidosis are rapid intravascular volume repletion, correction of hyperglycemia and acidosis, and prevention of hypokalemia. […] Intravascular volume should be restored rapidly to raise blood pressure and ensure glomerular perfusion; once intravascular volume is restored, remaining total body water deficits are corrected more slowly, typically over about 24 hours. […] Hyperglycemia is corrected by giving regular insulin 0.1 unit/kg IV bolus initially, followed by continuous IV infusion of 0.1 unit/kg/hour in 0.9% saline solution. […] Insulin should be withheld until serum potassium is 3.3 mEq/L (3.3 mmol/L). […] Prevention of hypokalemia requires replacement of 20 to 30 mEq (20 to 30 mmol) potassium in each liter of IV fluid to keep serum potassium between 4 and 5 mEq/L (4 and 5 mmol/L). […] If bicarbonate is used, it should be started only if the pH is 7, and only modest pH elevation should be attempted with doses of 50 to 100 mEq (50 to 100 mmol) given over 2 hours, followed by repeat measurement of arterial pH and serum potassium.

• #84 LearnPICU – DKA

  https://www.learnpicu.com/endocrine/DKA

  The anion gap is the primary lab you want to follow to assess resolution of ketoacidosis. While the pH and HCO3 level are useful, they also can be misleading as iatrogenic hyperchloremia from use of isotonic saline can cause a mild non-gap metabolic acidosis of little consequence. Nonetheless, if the institution uses a bicarbonate or pH cutoff (rather than a close anion gap), this may delay the transition to subcutaneous insulin and out of the PICU so consider substituting chloride with acetate when the patient is improving […] Once their anion gap has closed (6-10) and they are willing to eat, it is safe to transition them to subcutaneous insulin (though institutional criteria for transitioning may vary) with recommendations from pediatric endocrinology. In transitioning, give the patient their dose of subcutaneous insulin with their meal and leave the insulin infusion on for 30 minutes before shutting off, ensuring no period without insulin. You can discontinue the IV fluids as patients should be able to drink and rehydrate themselves although some elect to continue non-dextrose containing IV fluids. They are now ready to transition the general care ward.

• #85 08. Diabetic Ketoacidosis | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/content/08-diabetic-ketoacidosis

  Insulin bolus, if not already given in the emergency department: 0.1 units/kg IV push. […] Insulin infusion: begin continuous infusion of regular insulin of 0.1U/kg/hour (this is 5-7 units/hour for many patients). […] Aim to correct BG by 50-70 mg/dL per hour. […] Patients with euglycemic DKA will require both insulin and glucose administration. […] Switch from insulin infusion to subcutaneous insulin when blood glucose is 200mg/dL, and two of the following three are met: […] Non-gap metabolic acidosis: even when the anion gap has closed, there will be a non-gap metabolic acidosis due to renal excretion of ketotic anions (HCO3 equivalents), with chloride retention. This will normalize as the body restores its buffer stores. […] Primary goal is to achieve metabolic control by closing the anion gap prior to normalizing blood sugar levels. […] Start potassium replacement even when potassium in normal range. […] Consider infectious or ischemic precipitants.

• #86 Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population

  https://www.mdpi.com/2673-396X/3/4/66

  The use of SGLT2 inhibitors has been increasingly associated with an increased risk of DKA primarily in patients with type-1 diabetes and to a lesser extent in type-2 diabetes. […] Development of euglycemic DKA and ketonemia remain the most dangerous side effects for patients who develop DKA while on SGLT inhibitor therapy. […] For the management of possible DKA associated with insulin pump therapy, first the pump-related problem should be identified and rectified. […] Standard DKA treatment protocols are followed as described earlier (Section 2.1), with careful monitoring of ketone levels and allowing patients to consume carbohydrates.

• #87 Management of Euglycemic Diabetic Ketoacidosis

  https://www.uspharmacist.com/article/management-of-euglycemic-diabetic-ketoacidosis

  Step 1Stop Inciting Agent, if Applicable: In the case of EDKA induced by SGLT2i or drug intoxication, the inciting agent(s) must be discontinued as soon as EDKA is diagnosed. An appropriate medication reconciliation is important to assist in establishing differential diagnoses including EDKA as well as helping determine optimal management. […] Step 2Start Fluid Replacement With Monitoring of Electrolytes and Ketones: Fluid resuscitation should be the focus of initial management in EDKA. Fluid loss due to EDKA can range from 6 L to 9 L, and rehydration is necessary for adequate tissue perfusion and resolution of metabolic abnormalities. The American Diabetes Association recommends 1 L/hour to 1.5 L/hour of normal saline or lactated Ringers solution during the first 1 to 2 hours of fluid resuscitation. Treatment with IV fluid supplementation should continue as appropriate based on patient factors until the anion gap closes and acidosis has resolved. Ketones and electrolytes should be monitored hourly and every 2 hours, respectively, until blood ketones are 0.6 mmol/L and electrolytes are stabilized.

• #88 Diabetic Ketoacidosis (DKA) – EMCrit Project

  https://emcrit.org/ibcc/dka/

  NAGMA should be treated with IV bicarbonate to achieve a bicarbonate level 18-20 mEq/L before discontinuing the insulin infusion. […] Restart the insulin infusion. […] The primary problem with DKA is ketoacidosis (not hyperglycemia). Therefore, our overall goal is to titrate insulin as needed to treat the ketoacidosis. […] Long-acting insulin should be started early (well in advance of discontinuing the infusion). […] Avoid aggressive volume administration. […] For euvolemic patients, D10W may be superior to D5W to avoid causing hyponatremia. […] If beta-hydroxybutyrate is available, this is arguably the best way to determine the severity of the ketoacidosis. […] Treatment overall is very similar to DKA in general, with a few nuances: Aggressive IV dextrose must be started immediately.

• #89 Management of Euglycemic Diabetic Ketoacidosis

  https://www.uspharmacist.com/article/management-of-euglycemic-diabetic-ketoacidosis

  Step 4Start Dextrose Administration: EDKA treatment requires that dextrose 5% (D5W) be added to fluids because of BG concentrations 250 mg/dL. Dextrose must be given to restore normal cellular utilization, resulting in enhanced clearance and reduced production of ketone bodies. The addition of D5W to fluids also prevents hypoglycemia by serving as an exogenous source of glucose in the setting of insulin utilization. If ketoacidosis persists despite administration of D5W, dextrose 10% may be used.

• #90 Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/92/1/33

  In the event of an emergency that necessitates fasting and the patient has not been able to discontinue the SGLT-2 inhibitor, an intravenous drip with dextrose (glucose 45 g per hour) to offset starvation and either a basal insulin dose or an intravenous insulin infusion, depending on the clinical status of the patient, must be started to induce a favorable insulin-to-glucagon ratio and to stop ketogenesis. […] The primary goal of fluid administration is to restore tissue perfusion. […] In EDKA, hydration must be started with a dextrose-containing fluid to accomplish 4 crucial goals: provide glucose to stop the ketogenic process, reinstitute secretion of endogenous insulin, if present, thereby starting to alter the insulin-to-glucagon ratio in favor of insulin, stopping the ketogenic process, rehydrate and replete solutes, counterbalance the effects of the infused insulin that was started to enhance recovery from ketoacidosis.

• #91 Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/92/1/33

  Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. […] The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. […] Management of DKA requires strict discipline and a hierarchal approach: fluid administration; electrolyte and, especially, potassium control; and hyperglycemia therapy. […] When ambient glucose levels are less than 200 to 250 mg/dL at presentation or during treatment, or if there is a history of SGLT-2 inhibitor therapy, the initial intravenous fluid must contain dextrose.

• #92

  https://myhealth.alberta.ca/Learning/insulin-pump-therapy/DKA

  Diabetic ketoacidosis (also called DKA for short) is a problem that can happen because of diabetes. DKA happens when there isnt enough insulin in your body. Too little insulin leads to a buildup of acids, called ketones, in your blood. DKA can cause death. […] But people on insulin pumps have a much higher risk. […] If their infusion stops and they dont know, or they miss a bolus, they can have dangerously high blood glucose or DKA in just 2 to 4 hours. […] There are a few reasons why the insulin pump might stop giving insulin and cause DKA: The infusion site (where the cannula goes into your skin) has been used for too long, is irritated, or infected. The cannula or tubing has a bad connection, kink, or leak. The pump stops working properly or a part breaks. The pump programming isnt working properly.

• #93

  https://myhealth.alberta.ca/Learning/insulin-pump-therapy/DKA

  Diabetic ketoacidosis (also called DKA for short) is a problem that can happen because of diabetes. DKA happens when there isnt enough insulin in your body. Too little insulin leads to a buildup of acids, called ketones, in your blood. DKA can cause death. […] But people on insulin pumps have a much higher risk. […] If their infusion stops and they dont know, or they miss a bolus, they can have dangerously high blood glucose or DKA in just 2 to 4 hours. […] There are a few reasons why the insulin pump might stop giving insulin and cause DKA: The infusion site (where the cannula goes into your skin) has been used for too long, is irritated, or infected. The cannula or tubing has a bad connection, kink, or leak. The pump stops working properly or a part breaks. The pump programming isnt working properly.

• #94 Diabetic ketoacidosis – WikEM

  https://www.wikem.org/wiki/Diabetic_ketoacidosis

  Patients in DKA are almost always K+ depleted despite initially fairly normal K+. […] Administer 20-30cc/kg lactated ringers bolus during the first hour. […] Most important step in treatment since osmotic diuresis is the major driving force. […] Increased systemic perfusion may transport insulin to previously unreached receptor sites, inhibiting ketogenesis. […] Use of LRs is preferred over NS. […] Check potassium prior to insulin treatment! Do not administer insulin until potassium supplementation is underway. […] A bolus dose is unnecessary and may contribute to increased hypoglycemic episodes. […] If the patient comes in wearing an insulin pump, turn off the pump and remove the subcutaneous catheter. […] Expect BS to fall by 50-100mg/dL per hr if you administer 0.1units/kg/hr of insulin.

• #95 Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population

  https://www.mdpi.com/2673-396X/3/4/66

  The use of SGLT2 inhibitors has been increasingly associated with an increased risk of DKA primarily in patients with type-1 diabetes and to a lesser extent in type-2 diabetes. […] Development of euglycemic DKA and ketonemia remain the most dangerous side effects for patients who develop DKA while on SGLT inhibitor therapy. […] For the management of possible DKA associated with insulin pump therapy, first the pump-related problem should be identified and rectified. […] Standard DKA treatment protocols are followed as described earlier (Section 2.1), with careful monitoring of ketone levels and allowing patients to consume carbohydrates.

• #96 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and identify DKA early enough, you may be able to treat it from home with specific instructions from your healthcare provider. If you think you might be developing DKA, call your provider immediately. Theyll determine if youll be able to treat it from home or if youll need to go to the hospital. […] Hospital treatment of DKA includes: IV fluids: IV fluids help to correct dehydration, clear ketones through your pee and correct electrolyte imbalances. Insulin: Your healthcare team may give you insulin through an IV or as a needle injection (subcutaneous shot). Other treatments: Depending on the severity of DKA, your healthcare team may give you other treatments to help you recover. You may also need treatment for the underlying trigger of DKA, like antibiotics for a bacterial infection.

• #97 Diabetic Ketoacidosis | Endocrinology and Diabetes

  https://health.ucdavis.edu/conditions/endocrinology-diabetes/diabetes/diabetic-ketoacidosis

  Diabetic ketoacidosis (DKA) can quickly become a life-threatening emergency. Our team of specialists provides world-class care to treat DKA and help you avoid it. […] Our team delivers immediate, advanced treatment for diabetic ketoacidosis (DKA). […] Our diabetes specialists help many people treat early-stage DKA at home. We guide you through what to eat and drink, how much insulin to take and when to test your glucose and ketone levels. […] If your DKA is in a later stage or at-home treatment isn’t enough, you need emergency medical care. At UC Davis Health, you receive the highest quality treatment from a skilled team of experts. Your care may include: […] Dehydration is a common part of DKA. Our team will provide IV fluids and electrolytes to help restore your hydration levels.

• #98 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #99 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #100 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #101 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #102 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #103 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following: Follow your providers instructions: Theyll tell you how much insulin and/or medication to take and other steps to safely get out of DKA. Check your blood sugar often: Try to check your blood sugar every hour to be sure your treatment is working and your blood sugar is decreasing safely. Check your ketones: Use urine ketone strips or a blood ketone meter to check for ketones as youre recovering. The level of ketones in your body should be decreasing, not increasing. Drink fluids to prevent dehydration: Drink water, broth or sugar-free drinks to stay hydrated. This is especially important if youre sick and/or vomiting. Try to eat normally: Its important to eat as you normally do, especially if youre sick. If you take insulin, be sure to take the appropriate amount with your meal as directed by your provider. […] With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. Depending on the severity of DKA, it could take multiple days before its fully treated.

• #104

  https://link.springer.com/article/10.1007/s40138-012-0001-3

  The standard is an initial intravenous bolus of regular insulin 0.1 units/kg body weight followed by a continuous infusion of regular insulin at a dose of 0.1 unit/kg/h. […] In mild, uncomplicated cases of DKA a subcutaneous regimen of newer rapid-acting insulin analogues (insulin aspart, lispro, glulisine) have been proposed as safe and effective alternatives to the use of intravenous regular insulin in prospective, randomized trials. […] The following criteria mark the resolution of DKA according to the ADA guidelines: glucose 200 mg/dL, serum bicarbonate 18 mEq/L, serum anion gap 12 mEq/L and a venous pH of 7.3. […] Bicarbonate replacement is a controversial issue and a unified consensus is lacking. […] Proponents of alkali therapy argue severe metabolic acidosis is associated with intracellular acidosis and end organ dysfunction, particularly its deleterious cardiopulmonary effects. […] Once a patient is successfully treated and transitioned to a subcutaneous insulin regimen the focus should turn to prevention of future episodes.

• #105 Diabetic ketoacidosis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000320.htm

  The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids and bodily chemicals lost through urination, loss of appetite, and vomiting if you have these symptoms. […] If you have diabetes, it is likely your health care provider told you how to spot the warning signs of DKA. If you think you have DKA, test for ketones using urine strips. Some glucose meters can also measure blood ketones. If ketones are present, contact your provider right away. Do not delay. Follow any instructions you are given. […] It is likely that you will need to go to the hospital. There, you will receive insulin, fluids, and other treatment for DKA. Then providers will also search for and treat the cause of DKA, such as an infection.

• #106

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.) […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. […] If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 14.0 mmol/L. Call your doctor or nurse advice line if your ketone level is moderate or high. […] If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor or nurse advice line. If you start to feel sleepy or confused, call 911.

• #107 Diabetic ketoacidosis (DKA) | Ketosis symptoms and treatment | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/diabetic-ketoacidosis

  Your blood sugar levels could be higher than normal when you are unwell, putting you at risk of DKA. So, its a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. […] These usually include drinking more sugar free fluids, taking more insulin and checking your blood sugars more often than you usually would. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you (or your child). […] […] […] If you have high ketone levels in your blood and suspect DKA, you should get medical help straight away. Find your nearest AE. […] If your ketone levels are above 3mmol you should always get medical help straight away.

• #108 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  An endocrinologist also may be consulted to assist with management after the patient has been stabilized adequately. […] Frequent blood glucose monitoring at home makes DKA less likely, as this allows them to promptly search for possible reasons for unexpectedly high blood sugar values before the condition progresses to DKA.

• #109 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%, reduces severe hypoglycaemia, improves glycaemic control and improves quality of life. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality.

• #110 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%, reduces severe hypoglycaemia, improves glycaemic control and improves quality of life. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality.

• #111

  https://myhealth.alberta.ca/Learning/insulin-pump-therapy/DKA

  Diabetic ketoacidosis (also called DKA for short) is a problem that can happen because of diabetes. DKA happens when there isnt enough insulin in your body. Too little insulin leads to a buildup of acids, called ketones, in your blood. DKA can cause death. […] But people on insulin pumps have a much higher risk. […] If their infusion stops and they dont know, or they miss a bolus, they can have dangerously high blood glucose or DKA in just 2 to 4 hours. […] There are a few reasons why the insulin pump might stop giving insulin and cause DKA: The infusion site (where the cannula goes into your skin) has been used for too long, is irritated, or infected. The cannula or tubing has a bad connection, kink, or leak. The pump stops working properly or a part breaks. The pump programming isnt working properly.

• #112 Diabetic Ketoacidosis Treatment At Home: Several Options

  https://diabetesmantra.com/diabetes/treatment/diabetic-ketoacidosis-at-home/

  Diabetic ketoacidosis (DKA) is a serious condition that requires immediate medical attention and cannot be safely treated at home. It occurs when high levels of ketones accumulate in the blood, leading to acidosis. Treatment typically involves hospitalization to administer intravenous fluids, insulin therapy, and electrolyte replacement. These measures are critical to quickly and effectively restore the body’s balance of fluids and electrolytes, lower blood sugar levels, and address any complications that may arise. […] DKA is a medical emergency that necessitates prompt treatment in a hospital setting to correct the underlying high blood sugar, acidosis, and electrolyte imbalances. If you suspect DKA, do not delay in seeking medical attention. […] While diabetic ketoacidosis (DKA) requires immediate medical attention and cannot be treated solely at home, there are important steps individuals with diabetes can take at home to manage the condition. These measures are primarily preventive and supportive:

• #113 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Intravenous insulin infusions have long been the standard of care for DKA treatment. However, recent guidelines have suggested that subcutaneous insulin can be used to treat mild to moderate DKA effectively. […] Given the significant risks and off-label nature of their use, SGLT-2 inhibitors should only be prescribed for a selected cohort of people with type 1 diabetes under the supervision of a specialist endocrinologist. […] Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter.

• #114

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.) […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. […] If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 14.0 mmol/L. Call your doctor or nurse advice line if your ketone level is moderate or high. […] If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor or nurse advice line. If you start to feel sleepy or confused, call 911.

• #115 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Intravenous insulin infusions have long been the standard of care for DKA treatment. However, recent guidelines have suggested that subcutaneous insulin can be used to treat mild to moderate DKA effectively. […] Given the significant risks and off-label nature of their use, SGLT-2 inhibitors should only be prescribed for a selected cohort of people with type 1 diabetes under the supervision of a specialist endocrinologist. […] Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter.

• #116

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.) […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. […] If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 14.0 mmol/L. Call your doctor or nurse advice line if your ketone level is moderate or high. […] If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor or nurse advice line. If you start to feel sleepy or confused, call 911.

• #117 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Intravenous insulin infusions have long been the standard of care for DKA treatment. However, recent guidelines have suggested that subcutaneous insulin can be used to treat mild to moderate DKA effectively. […] Given the significant risks and off-label nature of their use, SGLT-2 inhibitors should only be prescribed for a selected cohort of people with type 1 diabetes under the supervision of a specialist endocrinologist. […] Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter.

• #118

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.) […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. […] If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 14.0 mmol/L. Call your doctor or nurse advice line if your ketone level is moderate or high. […] If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor or nurse advice line. If you start to feel sleepy or confused, call 911.

• #119 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%, reduces severe hypoglycaemia, improves glycaemic control and improves quality of life. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality.

• #120 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%, reduces severe hypoglycaemia, improves glycaemic control and improves quality of life. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality.

• #121 Diabetic ketoacidosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/162

  Diabetic ketoacidosis (DKA) is characterised by a biochemical triad of hyperglycaemia (or a history of diabetes), ketonaemia, and metabolic acidosis, with rapid symptom onset. […] Successful treatment includes correction of volume depletion, ketogenesis, hyperglycaemia, electrolyte imbalances, and comorbid precipitating events, with frequent monitoring. […] DKA is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. […] Cerebral oedema, a rare but potentially rapidly fatal complication, occurs mainly in children. It may be prevented by avoiding overly rapid fluid and electrolyte replacement.

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