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Dka Management


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this presentation was present by my friend during emergency posting seminar with Dr.Mohd. Kamal Mohd. Arshad. I upload this ppt here for all of us and my own reference too.

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Dka Management

  1. 1. DKA management By RAZZI B. HAJEMI
  2. 2. Case scenario <ul><li>Mr SK 34 year old gentleman, was admitted to ED due to loss of consciousness. </li></ul><ul><li>A known case of diabetic and hypertension. </li></ul><ul><li>Experienced vomiting and abdominal pain before loss of consciousness. </li></ul>
  3. 3. Management plan <ul><li>IV access and start fluid(0.9% saline) </li></ul><ul><li>replacement immediately. </li></ul><ul><li>Check plasma glucose: usually >20mmol/L </li></ul><ul><li>If so, give 4-8u soluble insulin IV </li></ul><ul><li>Investigation </li></ul>
  4. 4. investigation <ul><li>Lab glucose, U&E, HCO - 3 , osmolality, blood gases, FBC, and blood culture. </li></ul><ul><li>urine test: ketones, CXR(pneumonia) </li></ul>
  5. 5. <ul><li>NG tube only if nauseated/ vomiting/ unconscious </li></ul><ul><li>insulin sliding scale </li></ul><ul><li>Continue fluid replacement, K + replacement </li></ul><ul><li>Check glucose and U&E, HCO - 3 regurlarly </li></ul>
  6. 6. Insulin sliding scale Hourly glucose result (mmol/L) Soluble insulin If infection or insulin resistance 0-3.9 0.5u/h 1u/h 4-7.9 1 2 8-11.9 2 4 12-16.0 3 6 >16 4 8
  7. 7. Fluid replacement <ul><li>Give 1L of 0.9% saline stat. Then typically, 1L over the next hour, 1L over 2 hour, 1L over 4 hour, then 1L over 6 hour. </li></ul><ul><li>Use dextrose saline or 5% dextrose when blood glucose is <15mmol/L. </li></ul><ul><li>Those >65yrs or with ccf need less saline more cautiously. </li></ul>
  8. 8. K + replacement Serum potassium (mmol/L) Amount of KCL add per litre of IV fluid <3.0 40mmol 3-4 30mmol 4-5 20mmol