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.

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

8. 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

10. 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

11. 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 1st hour.
 When blood Glucose reaches 200-250, Insulin rate decreased by
50 %

12.  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.

13. 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.

14.  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 .

15. 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.

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