Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the dkahhs itself. To address these issues the joint british diabetes societies jbds, supported by nhs diabetes, has produced this revision of the 2010 guidance developed by a multidisciplinary group of practicing specialists with considerable experience in this area. In patients aged 16 years presenting with dka, the management of dka should be discussed with relevant paediatric staff. This will include the diabetic diet carbs, fats, proteins, exercise regime how to. Endocrine emergencies postgraduate medical journal. In the last decade, however, there has been a change in the way patients with dka present clinically and in addition there has been rapid development of nearpatient testing. Clinical endocrinologists worldwide rely on endocrine practice, the official journal of the american association of clinical endocrinologists aace, to keep them on the leading edge of treatment of patients with endocrine diseases. For more information refer to chqgdl60016 diabetic ketoacidosis dka emergency management in children dka emergency management in children flowchart child with dka diagnosis bgl11 mmoll, ph management of diabetic ketoacidosis. The nursing management approach to patients with dka is similar to that of. We are dedicated to providing the field of endocrinology with timely, evidencebased recommendations for clinical care and practice. Guidelines for management of diabetic ketoacidosis the lancet.
Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Internationally respected endocrine practice is the journal for clinical endocrinologists. Backgrounddiabetic ketoacidosis dka is an endocrine emergency with associated risk of morbidity and mortality. Endocrine emergencies pose unique challenges for the attending intensivist while managing critically ill patients. Endocrine disorders and therapeutic management flashcards. Review of evidence for adult diabetic ketoacidosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Dka results in acute metabolic derangement in dogs and cats, requiring prompt medical treatment. Diabetic and endocrine emergencies denver, colorado. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. Obtain endocrine consult on all patients on continuous tube feeds or new type 1 dm and others as needed. Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counter.
Management of dka should be mainly directed to correction of acidosis. Diabetic and endocrine emergencies t kearney, c dang. Dka represents the initial manifestation of t1d in 80% of cases and it can also occur in 25% of cases of type 2 diabetes at onset. Adult diabetic ketoacidosis dka guidelines and management record ward doctor surname umrn given names dob gender address postcode telephone these guidelines are for the treatment of adults with diabetic ketoacidosis dka and are designed to allow both prescriptions and relevant observations to be recorded together. Management of diabetic ketoacidosis in adults clinical guideline v4. The goals of medical management are rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetic ketoacidosis dka diagnosis, pathophysiology. The therapeutic goals of dka management include optimization of 1. People with dka and hhs are best managed in an intensive care unit or stepdown setting 1,31,32 with specialist care 39,40.
Dka diabetes self management education and support consults endocrine if not primary service nutrition social work discharge appointment followup with endocrinology 23 weeks after discharge inclusion criteria new diabetes diagnosis requiring teaching for insulin use exclusion criteria diabetic ketoacidosis dka use. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Despite this, dka management lacks strong evidence due to the absence of large randomised controlled trials rcts. Background diabetic ketoacidosis dka is a costly, acute and life threatening complication of diabetes hospital admissions for dka are increasing. Diabetic ketoacidosis dka is a common endocrine emergency in veteri nary medicine. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with hhs.
There is debate as to whether physicians treating dka can prevent or predict the occurrence of cerebral edema and the appropriate sitesforchildrenwithdkatobemanaged. The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes primarily. Dka hhs ispad consensus guidelines pediatric diabetes. Interventions to improve dka management are effective in improving. British society of paediatric endocrinology and diabetes bsped guidelines for. Guidelines for the management of patients with dka and hhs. Specific guidelines exist for the management of dka in children. Management of acute diabetic ketoacidosis dka below is the link to the care pathway for the management of diabetic ketoacidosis in adults.
Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in. Volume status including fluid intake and output, vital signs. Most will see diabetic emergencies on a regular basis, as they are common and both type 1 and type 2 disease are increasing in prevalence. Protocols and insulin management software systems 41 may be beneficial 42,43, but there can be challenges with achieving adherence 44,45. Guidelines for management of diabetic ketoacidosis. Hyperglycemic emergencies diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are common presentations in the ed that require swift, specialized management strategies. Flow chart for diabetic ketoacidosis in adults management of. Diabetic emergencies are usually easily treated and the patients discharged. Diabetic ketoacidosis dka is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus tidm. Lawson wilkins pediatric endocrine society lwpes, european society for pediatric endocrinology espe, and the international soci. Dka management and outcomes international journal of.
Diabetes mellitus pharmacology medications nclex nursing. The underlying stimulus of hhs must be discovered and treated. C 22 subcutaneous insulin can be used for treatment. British society of paediatric endocrinology and diabetes bsped guidelines for the management of. Joint british diabetes societies inpatient care group. Aace members devote a significant part of their career to the evaluation and management of patients with endocrine disease. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Diabetic ketoacidosis and hyperosmolar hyperglycemic. To determine the efficacy and safety of a diabetic ketoacidosis dka power plan pp for guiding intravenous iv insulin infusions prior to anion gap ag closure and administering subcutaneous sc insulin. Guidelines american association of clinical endocrinologists.
Management the treatment goals for dka and hhs are to correct the fluid depletion, decrease the blood glucose level, correct the electrolyte imbalance and treat the precipitating causes. European society for paediatric endocrinologylawson. Diabetic ketoacidosis dka management algorithm adult. Management of diabetic ketoacidosis in adults clinical. To determine the efficacy and safety of a diabetic ketoacidosis dkapower plan pp for guiding intravenous iv insulin infusions prior to anion gap ag closure and administering subcutaneous sc insulin. Mortality is predominantly related to the occurrence of cerebral edema. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. In addition, dka is a common complication in patients with known diabetes, where it may be the consequence of illness. Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. Guidelines and position statements from medical the care of their patients. Fluid and electrolyte therapy in endocrine disorders. Understand diabetic ketoacidosis dka with this free medical course.
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