DIABETIC KETOACIDOSIS 2023.pptx

Causes and management of diabetic ketoacidosis

1. DIABETIC KETOACIDOSIS AND MANAGEMENT

2. A COMPLICATION OF DIABETES MELLITUS TYPE 1. HAPPENS WHEN GLUCOSE LEVELS INCREASE TO 250-500.

3. SIGNS AND SYMTOMS POLYDYPSIA POLYURIA HYPOTENSION WEAKNESS WEIGHT LOSS NAUSEA ABDOMINAL PAIN KUSSMAUL BREATHING ALTERED SENSORIUM ACETONE BREATH

4. DIAGNOSTIC CRITERIA Blood Glucose 250 mg/dl Arterial ph <7.3 Anion Gap > 10-12 Decreased total Potassium Bicarbonates < 18 mEq /L Positive serum and urine ketones Acetoacetate – Low concentration but has high specificity Betahydroxybutyrate - Abundant but requires specific assay

5. FLUID THERAPY Fluid loss averages app 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 first 8-12 hours. A crystalloid fluid is the initial choice. A Bolus-0.9 % Nacl I/V (Isotonic) at 15-20 ml/kg/hr Followed by, 0.45 % Saline at 4-14 ml/kg/hr

6. INSULIN THERAPY IV Insulin is a preferred route of Insulin delivery in DKA. Ensure K >3.34 mEq /L before initiation of Insulin. Initial Bolus- 0.1 U/KG , followed by continuous Insulin infusion at 0.1 U/kg/h. Expected – 10 % falling in blood glucose levels by 1 st hour. When blood Glucose reaches 200-250, Insulin rate decreased by 50 %

7. Serum K should be closely monitored during Insulin infusi on. K <3.3, Insulin infusion stopped , 20-30 mEq /l administered. If Blood Glucose <200 – Give Dextrose containing fluids. Bicarbonate therapy may be indicated if pH < 6.9.

8. COMPLICATIONS Hypoglycemia is the most common complication. Prevented by timely adjustment of Insulin dose and frequent monitoring of blood Glucose levels. Id DKA is not resolved, and blood Glucose level is below 200-250 mg/dl, decrease in Insulin infusion rate or add 5%-10% Dextrose to current IV fluids.

9. Cerebral edema due to rapid reduction in serum osmolality has also been reported in young adult patients. Rhabdomyolysis Pulmonary edema develops from excessive fluid replacement .

10. RECENT TRIAL Clinical importance of initial insulin bolus In Insulin management of DKA has been recently challanged in a study that compared efficacy and safety of two strategies of Insulin infusion – with and without priming bolus. Conclusion- There were no differences in outcomes between a group treated with a regular insulin infusion at 0.14U/kg/h without administration of initial Insulin bolus and a group of patients who were given bolus of 0.07U/kg followed by infusion at 0.07U/kg/h.

11. It also showed no significant difference in incidence of hypoglycemia, rate of glucose change or anion gap, length of stay between 2 groups.