One of the most severe complications of diabetes, diabetic ketoacidosis dka, results from insulin deficiency and is a medical emergency that is frequently encountered in the emergency department. Uncontrolled blood glucose levels may lead to hyperglycaemia or hypoglycaemia. Diabetic ketoacidosis dka is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus. Diabetic ketoacidosis is a common illness among patients with diabetes. Ketonuria may persist for more than 36 hours due to the slower removal of acetone. It can be lifethreatening, but it usually takes many hours to become that.
Joint british diabetes societies inpatient care group. Diabetic coma is a medical emergency and needs prompt medical treatment. D rao v 1, b pradhan 2, y mallikarjuna 1, r reddy 1. Diabetic ketoacidosis is a buildup of acids in your blood. Evidencebased management oypferglycemic emergenciesh in diabetesmellitus.
Clinical profile of diabetic ketoacidosis in adults. Diabetic ketoacidosis happens when a persons insulin levels in the blood become dangerously low. Diabetic ketoacidosis carries a significant mortality rate and close monitoring is essential. Nurse practitioners are well positioned to promote patient education, self management, and individualized patient care. The metabolic derangements and treatment of diabetic. Uk dka guidelines from the british society for paediatric endocrinology and diabetes. Management of diabetic ketoacidosis in adults age 16 years. This is the first reported live case with such high values of blood glucose and a. Jun 30, 2014 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 is a buildup of acids in your blood.
These images are a random sampling from a bing search on the term diabetic ketoacidosis management in children. Diabetic ketoacidosis dka, a lifethreatening complication of diabetes mellitus dm, occurs more commonly in children with type 1 dm than type 2 dm. Diabetic ketoacidosis is when insulin is low and ketone levels are high. This article outlines updates in the clinical management of.
Both diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are medical emergencies that require prompt recognition and management the initial evaluation of patients approach to the adult with brittle diabetes or high glucose variability view in chinese. When blood sugar levels are too high and insulin levels are too low. Apr 25, 2014 diabetic ketoacidosis, together with the major complication of cerebral edema, is the most important cause of mortality and severe morbidity in pediatric cases of diabetes, particularly at the time of first diagnosis. Symptoms of diabetic ketoacidosis include dehydration, abdominal pain, confusion, and nausea and vomiting. Its more common in people with type 1 diabetes, but those with type 2 diabetes can be affected, too. Diabetic ketoacidosis dka is a serious acute metabolic complication of diabetes, characterized by hyperglycemia, ketosis, and metabolic acidosis. Diabetes, a chronic medical condition, continues to increase in prevalence. The management of diabetic ketoacidosis in adults pdf. Weve helped produce the management of diabetic ketoacidosis in adults, pdf, 4mb published by the joint british diabetes societies inpatient car.
Full text management of adult diabetic ketoacidosis dmso. Dka onset and recurrence can largely be prevented through patient education. Diabetic ketoacidosis dka results from absolute or relative deficiency of circulating insulin kitabchi ae, umpierrez ge, murphy mb, kreisberg ra, 2006. You have been given this leaflet because you are taking a tablet for type 2 diabetes that may. The management of diabetic ketoacidosis in adults evidence.
Acute management of diabetic ketoacidosis in adults this protocol is for the acute management of diabetic ketoacidosis in patients 16 years and over. Management of diabetic ketoacidosis article nursingcenter. Management of diabetic ketoacidosis in adults queensland health. Diabetic ketoacidosis dka, though preventable, remains a frequent and life threatening complication. Diabetic ketoacidosis dka is a serious complication of diabetes where large amounts of ketones an acidic substance are produced and accumulate in the blood making the blood more acidic. Diabetic ketoacidosis diabetic ketoacidosis 2 american family physician. Introduction diabetic ketoacidosis dka is a potentially life threatening complication in people with diabetes mellitus. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to.
C 29, 32 bicarbonate therapy has not been shown to improve outcomes in persons with dka, but is recommended by consensus guidelines for persons with a ph less than 6. The three types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. Flow chart for diabetic ketoacidosis in adults management of. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. It could be lifethreatening, but it usually takes many hours to. Introduction hhs and dka are not mutually exclusive but rather two conditions that both result from some degree of insulin deficiency. September 20 this document has been endorsed by the intensive care society. Management of adult diabetic ketoacidosis aidar r gosmanov,1 elvira o gosmanova,2 erika dillardcannon3 1division of endocrinology, diabetes and metabolism, 2division of nephrology, department of medicine, 3department of microbiology, immunology, and biochemistry, university of tennessee health science center, memphis, tn, usa abstract.
In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. Flow chart for diabetic ketoacidosis in adults management of download overview national guidelines flowchart for the management of dka from the joint british diabetes societies inpatient care group. Whatyoushouldknow diabeticketoacidosis dka isacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%. Joint british diabetes societies inpatient care group the management of diabetic ketoacidosis in adults second edition update. Diabetic ketoacidosis dka is a lifethreatening condition caused by a buildup of waste products called ketones in the blood. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Updates in the management of diabetic ketoacidosis the. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Pdf clinical profile of diabetic ketoacidosis in adults. It occurs in people with diabetes mellitus when they have no, or very low levels of, insulin. Management of diabetic ketoacidosis am fam physician 1999 aug. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. The american academy of family physicians has a good public domain article on management of diabetic ketoacidosis. Diabetic ketoacidosis clinical quick talks society of.
Diabetic ketoacidosis dka is a rare but serious condition. Diabetic ketoacidosis dka, a lifethreatening complication of type 1 diabetes, is preventable but errors in the way it is managed are common and and associated with significant morbidity and mortality. Diabetic ketoacidosis dka results from deficiency of circulating insulin and increased levels of the coun terregulatory hormones. Most patients will develop a nongap acidosis unless ckd v, esrd due to resolving ketoacidosis after gap is closed. Part of the reason for this high level of use might be because of the lack of national guidelines in other countries. Diabetic ketoacidosis dka is a rare yet potentially. It can happen when your blood sugar is too high for too long. It happens predominantly in those with type 1 diabetes, but it can occ. May 31, 2019 diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes.
C 22 subcutaneous insulin can be used for treatment of uncomplicated dka. Diabetic ketoacidosis dka is the metabolic abnormality of type 1 diabetes. In the management of diabetic ketoacidosis the following guidance should therefore be followed. Objectives when the student has finished studying this module, heshe will be able. The criteria for hyperglycemic hyperosmolar state hhs include. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus.
Diabetic ketoacidosis is a serious complication of type 1 diabetes, though its sometimes seen in people with type 2 diabetes. Dka is characterized by severe depletion of water and electrolytes from both the intra and extracellular fluid compartments. The exact prevalence is unknown, but in one community the rate was estimated to be. Early recognition of dka, a good understanding of the pathological processes of dka, and aggressive treatment are the keys to successful treatment. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3.
Overview of the diagnosis and management of diabetic ketoacidosis. In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis dka with an average length of stay of 3. The management of diabetic ketoacidosis in children. Click on the image or right click to open the source website in a new browser window. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities result from a relative or absolute deficiency of insulin with or without an excess of. We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. Diabetic ketoacidosis dka management algorithm adult. Diabetic ketoacidosis is an acute complica tion of diabetes mellitus that can be lifethreatening if not treated properly. If a patient has elevated bgl and ketones but is not acidotic they need to be closely monitored and agressively managed to prevent progression to dka. 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. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities result from a relative or absolute deficiency of insulin with or without an excess of counterregulatory hormones. The management of diabetic ketoacidosis in adults our. With good care, dka can be managed and the patient will survive. It occurs at the time of diagnosis of type 1 diabetes in approximately onethird of children in the united states.
224 47 1239 873 368 990 217 192 959 1446 980 148 152 1476 1494 553 996 217 1048 1290 996 308 212 369 466 483 1287 481 666 464 493 1275 623 549