DKA care pathways
The care pathways for the emergency management of DKA should be used for all eligible patients. Complete pathways for 0–4 hours and 4 hours–discharge for each DKA episode. These provide instruction on fluid balance, insulin and potassium replacement.
Beside this, how does DKA cause cerebral edema?
Abstract. Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume.
Simply so, what are the three criteria for DKA?
Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.
What is the first line treatment for DKA?
Treatment usually involves: Fluid replacement. You’ll receive fluids — either by mouth or through a vein — until you’re rehydrated. The fluids will replace those you’ve lost through excessive urination, as well as help dilute the excess sugar in your blood.
What is the two bag method DKA?
Background: The “two-bag method” of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant.
When do you give potassium in DKA?
About two-thirds of patients will develop hypokalemia in the course of treatment for DKA. Potassium repletion should commence once the serum potassium falls below 5.3 mEq/L if patients have normal renal function. Twenty to 30 mEq of potassium may be supplemented to each liter of fluids.
When do you stop fixed rate insulin in DKA?
Never stop insulin infusion. Once plasma glucose or capillary glucose <14 mmol/L add 10% glucose IV infusion at 125ml/hr whilst continuing fluid replacement with 0.9% saline as above. Do not reduce insulin infusion rate in response to falling plasma glucose unless the ketone target has been met.
When does DKA pathway stop?
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
Why is potassium replaced in DKA?
After insulin treatment is initiated, potassium shifts intracellularly and serum levels decline. Replacement of potassium in intravenous fluids is the standard of care in treatment of DKA to prevent the potential consequences of hypokalemia including cardiac arrhythmias and respiratory failure.
Why is there no insulin bolus pediatric DKA?
The second important difference is the administration of insulin. While insulin is bloused in the adult patient, insulin boluses are contraindicated in the pediatric patient with DKA. Monitoring and correction of potassium is heavily stressed in the adult patient with DKA.