Joint british diabetes societies guideline for the management of diabetic ketoacidosis. Continuous intravenous insulin infusion management. This clinical guideline is based on recommended best practices. Hyperglycemic crises in adult patients with diabetes.
Management of diabetic ketoacidosis in adults queensland health. The biochemical criteria for the diagnosis of diabetic ketoacidosis. The biochemical criteria for the diagnosis of diabetic ketoacidosis dka are. Dka guideline for diagnosis hhs guideline for diagnosis. Safety of the protocol was evaluated by assessing the number of patients with hypoglycemic events, and the number of patients with hypokalemic. 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. For patients with uncomplicated dka, regular insulin should be given as an initial dose of 0. Euglycemic diabetic ketoacidosis edka is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3.
Dka without a preceding febrile illness or gastroenteritis in a patient with known diabetes is almost always the result of psychosocial problems and failure to appropriately administer insulin. Change in blood glucose trend insulin infusion titration. Diabetic ketoacidosis dka, though preventable, remains a frequent and life threatening complication. Diabetic ketoacidosis dka occurs when there is a relative or absolute decrease in circulating insulin levels in relation to an increase in counterregulatory hormone levels. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs guidelines for adults. One approach to delivering best clinical practices is development of inpatient standardized protocols for dka management. Diabetic ketoacidosis carries a significant mortality rate and close monitoring is essential. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Glucose levels will be evaluated by finger stick testing or blood testing 2. Diabetic ketoacidosis is a lifethreatening complication that affects people with diabetes. The criteria for hyperglycemic hyperosmolar state hhs include.
Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. Dka can happen to anyone with diabetes, though its much more common in people with type 1 diabetes. Endo diabetic admit order set meal time insulin guidelines 1 for all ages, if the patient is not in dka, the insulin dose should be guided by the endocrinologist with consideration of age, weight, and hyperglycemia. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Prebreakfast administer both glargine and aspart dose according to premeal aspart order set. Rn to contact pharmacy to make ns order prn bg 250 and make d50. Diabetic ketoacidosis american academy of pediatrics.
Keep serum glucose between 150 200 mgdl if cannot maintain glucose 150 mgdl despite d10 and diet then titrate insulin down to a minimum of 0. The goal is to improve the care of individuals with diabetes. Diabetes ketoacidosis dka orders clinical institute. This protocol is to be used for the management of diabetic ketoacidosis dka in adults over the age of 16.
In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. Diabetic ketoacidosis dka though preventable remains a frequent and life. Diabetic standard 2000 calorie diet iv fluids sodium chloride 0. The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management of diabetic ketoacidosis dka and hyperosmolar hyperglycaemia state. Diabetic ketoacidosis dka care guidelines emergency department management inclusion criteria definition of dka. In response to this imbalance, normal physiologic mechanisms are exaggerated, resulting in hyperglycemia, hyperosmolality, ketosis, and acidosis. Determine the average hourly rate over the last 8 hours in unitshr and multiply by 24 hours b. Diabetic ketoacidosis diabetic ketoacidosis dka is a state of uncontrolled diabetes and it is characterized by hyperglycemia, a high anion gap acidosis, and the presence of ketonemia and ketonuria ketone bodies in the blood and urine. This protocol is not to be used for patients in diabetic ketoacidosis dka. Diabetes insulin transition iv to subcutaneous adult supplemental 5254. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus.
Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. It is not intended to supersede clinical judgment in the care of the individual patient. Check hourly blood glucose bg levels upon initiation 3. Diabetic ketoacidosis symptoms, diagnosis and treatment. Although it can occur in patients with type 2 diabetes during periods of severe. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. Nearing 100 years of insulin availability, mortality related to diabetic ketoacidosis in the adult population has progressively declined to less than 1%.
Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis dka management algorithm adult. Determine the total daily insulin tdi requirement unitsday i. Diabetic ketoacidosis dka critical care guideline two. Diabetic ketoacidosis was a fatal disease before the discovery of insulin in 1921. Insulin deficiency, increased insulin counterregulatory hormones cortisol, glucagon, growth hormone, and catecholamines and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which underlie the pathophysiology of dka.
With three consecutive bg values within desired range, bg testing may be spaced to every 2. Blood glucose bg 200 mgdl acidosis bicarbonate 200 mgdl acidosis bicarbonate diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. 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. Flow chart for diabetic ketoacidosis in adults management of. Diabetic ketoacidosis dka care guidelines emergency.
Table 1 outlines the diagnostic criteria for dka and hhs. Diabetic ketoacidosis dka is a serious condition that can lead to diabetic coma passing out for a long time or even death. Kitabchi, phd, md 2 objective in this prospective, randomized, open trial, we compared the ef. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart guillermo e. Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Identify and treat the cause of the dka precipitation. Treatment of diabetic ketoacidosis with subcutaneous. When your cells dont get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Guidelines for management of diabetic ketoacidosis.
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