Diabetic Ketoacidosis

Clinical Features:

• 1)polyuria 
• 2)polydypsia
• 3)weight loss
• 4)weakness
• 5)Nausea,vomiting
• 6)Leg cramps
• 7)Blurred vision
• 8)Abdominal pain

O/E:

• 1)Dehydration
• 2)Hypotesion
• 3)cold extremities
• 4)Tachycardia
• 5)Air hunger
• 6)smell of acetone
• 7)hypothermia

investigation:

• 1)RBS
• 2)Urine for ketone body
• 3)serum urea & electrolyte
• 4)plasma bicarbonate
• 5)ABG
• 6)ECG
• 7)CBC,CRP
• 8)CXR

Rx:

• Complete bed rest
  
• High flow o2(4-6L)
  
• I/V cannula insertion
  
• Catheterization
  
• NG -if pt unconscious/senicionscous/
  
• CV line -if needed 

Fluid replacement: 0.9% normal saline I/V

• 1L Over 30 min
  
• 1 L over 1 hour
  
• 1 L over 2 hours
  
• 1 L over next 2-4 hours
  

When blood glucose < 15 mmol/l

Switch to 5%DA ,1 L 8 hourly

if still dehydrated 

,continue 0.9% normal saline add with 5% DA 1L per 12hourly

not more then 6L fluid in first 24 hours

🚏 Insulin:soluble 

• 50 unit soluble insulin in 50ml 0.9% saline I/V via insulin pump
  
• initially 6 unit/hour
  
• 3 unit/hour when blood glucose < 15 mmol/l
• 2 unit/hour if blood glucose decrease < 10 mmol/l

🚏 When insulin pump not available--

• 10-20 unit insulin I/M stat then 5 unit I/m hourly 
  
• check blood glucose hourly – if no reduction of blood glucose in first hour then dose increase
• Aim of blood glucose 3-6 mmol/l per hour

🚏 K+ Replacement::

• if K+ < 3.5 mmol/l, give 20 mmol in 1L of Fluid in one hour
  
• if K+ 3.5-5 mmol/l , give 10 mmol in 1L of Fluid in one hour
  
• if K+ > 5 mmol/l no need extra K+