Treatment of DKA requires first and foremost fluid resuscitation with 0.9% saline, followed by replacement for 5%–10% dehydration, depending on severity, and maintenance with 0.45% saline, and early and adequate K replacement.
In respect to this, how do you calculate fluid deficit in pediatrics DKA?
For most children, use
| Weight | |
|---|---|
| >60kg | 35 ml/kg/24 hrs |
Also, what is the 2 bag system?
The two bag system has been studied in the pediatric population and is used frequently in pediatric intensive care units. It involves two bags of identical fluids with electrolytes, except one bag has 0% dextrose and the other has 10% dextrose. The two fluid bags run simultaneously into a single IV.
What is the pathophysiology of DKA?
DKA is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. (See Etiology.)
What is the two bag system for 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.
What IV solution is used for diabetic ketoacidosis?
The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.
When is the anion gap closed?
In the hospital setting, you may hear the phrase “the anion gap is closed.” This often refers to the patient who is admitted to the hospital with ketoacidosis from uncontrolled diabetes. Typically, IV fluids and an insulin drip are administered until the gap is closed, and then a maintenance regimen may begin.
When should insulin infusion be given in DKA?
Insulin therapy after resolution of DKA
When the patient is able to tolerate oral intake and DKA is resolved, transition to subcutaneous insulin must be initiated. It is common to see transition from intravenous to subcutaneous insulin using sliding scale insulin only.
Why do we give dextrose in DKA?
Why is IV dextrose given to patients with DKA? When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr.
Why is urine checked for ketones in a DKA patient?
This produces a substance called ketones, which can show up in your blood and urine. High ketone levels in urine may indicate diabetic ketoacidosis (DKA), a complication of diabetes that can lead to a coma or even death. A ketones in urine test can prompt you to get treatment before a medical emergency occurs.