What are the three key actions for the management of DKA?
Table of Contents
What are the three key actions for the management of DKA?
Key DKA management points
- Start intravenous fluids before insulin therapy.
- Potassium level should be >3.3 mEq/L before the initiation of insulin therapy (supplement potassium intravenously if needed).
- Administer priming insulin bolus at 0.1 U/kg and initiate continuous insulin infusion at 0.1 U/kg/h.
What is the BGL for DKA?
The biochemical criteria for the diagnosis of DKA: Hyperglycaemia: blood glucose level (BGL) > 11mmol/L. Ketonaemia (blood beta hydroxybutyrate > 3mmol/L or moderate or large ketonuria. Acidosis: venous pH <7.3 or bicarbonate < 15mmol/L.
Why is potassium given in DKA?
Replacement of potassium in intravenous fluids is the standard of care in treatment of DKA to prevent the potential consequences of hypokalemia including cardiac arrhythmias and respiratory failure.
Do you give potassium before insulin in DKA?
The American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) consensus statements for managing DKA recommend checking serum potassium prior to insulin treatment and ongoing monitoring of serum potassium levels with replacement in intravenous fluids (3, 4).
When do you give bicarbonate in DKA?
Introduction. Many patients with severe DKA receive bicarbonate when their arterial pH falls below 7.10. The benefits of bicarbonate therapy include improved myocardial function, decreased vasodilation and a reduction in the incidence of ventricular arrhythmias.
When do you give sodium bicarbonate in DKA?
Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9.
Why is Ringer lactate not given in DKA?
The infusion of Ringer’s lactate may also cause elevations in serum lactate levels [25, 26], which may be exaggerated in liver failure and could in turn affect clinical decision-making. The lactate in Ringer’s may be converted to glucose and could exacerbate hyperglycemia in the DKA and HHS setting [27].
Why do you give dextrose in DKA?
Why is IV dextrose given to patients with DKA? When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr.
Why use half normal saline in DKA?
SWITCHING TO HALF-NORMAL SALINE The goal of treating DKA is to slowly allow the BG and hyperosmolality to normalize, which initially requires the use of isotonic fluids, i.e. normal (0.9%) saline.
