Description
When your body produces a lot of the blood acids known as ketones, or ketones, it can lead to a serious complication of diabetes called diabetic ketoacidosis. When your body can't create enough insulin, the problem sets in. Sugar (glucose), a main source of energy for your muscles and other tissues, generally enters your cells with the aid of insulin. Insufficient insulin causes your body to start using fat as fuel. If left untreated, this process results in a buildup of acids in the blood called ketones, which eventually cause diabetic ketoacidosis. In diabetic ketoacidosis patients, the fluid deficit may be as much as 10% to 15% of body weight. Immediate fluid resuscitation is essential to treat hypovolemia, restore tissue perfusion, and clear ketones. Independent of insulin, hydration enhances glycemic control.
Résumé
- Diabetic Ketoacidosis (DKA) is an acute complication of diabetes, more common in type 1 but possible in type 2. The initial approach involves rapid assessment and immediate action, even before lab results are available. Fluid resuscitation is the primary goal in the first hour, using isotonic saline (0.9% NaCl) at 15-20 ml/kg body weight. The focus initially is not on controlling hyperglycemia or ketosis.
- In the subsequent two hours, isotonic saline continues at 500-1000 ml/hour. After this, serum sodium levels are monitored closely, as isotonic saline can cause elevated sodium. If sodium levels are normal or high, hypotonic saline (0.45% NaCl) at 250-500 ml/hour is administered. The goal is to maintain serum sodium between 135-145 mEq/L.
- Potassium management is crucial, especially after starting insulin therapy. Insulin can cause hypokalemia by shifting potassium intracellularly. Potassium levels should be checked hourly after insulin initiation. Potassium supplementation (10-20 mEq/L) is needed if serum potassium falls below 3.3 mEq/L.
- Bicarbonate administration is not always necessary in DKA management. It is primarily considered in severe metabolic acidosis, when pH is below 7.0. Otherwise, it's often not required as the primary focus is on fluid resuscitation and electrolyte balance.
- In cases where immediate blood sugar testing isn't available, 25ml of 50% dextrose can be administered. If a glucometer subsequently reveals a blood sugar of only 26 mg/dL and the patient recovers after dextrose administration, admission should be considered, especially if there is evidence of infection. Medications known to lower blood sugar, like long-acting insulin and sulfonylureas, should be approached with caution in this scenario.
- In cases with negative urine ketones despite suspected DKA and acidotic breathing, the patient may predominantly excrete beta-hydroxybutyrate. Standard urine ketone tests may not accurately detect this specific ketone body, requiring alternative methods for confirmation. DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis.
Exemple de certificat
À propos des intervenants
Dr Swathi
Professeur adjoint, biochimie, Institut des sciences médicales Datta Megha, Wardha
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