+ This lecture was conducted during the Nephrology Unit Grand Ground by Nephrology Registrar under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
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+ This lecture was conducted during the Nephrology Unit Grand Ground by Nephrology Registrar under Nephrology Division, Department of Medicine in King.
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+This lecture was conducted during the Nephrology Unit Grand Ground by Nephrology Registrar under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
+
Hanan MalSub-intern
Diabetic Ketoacidosis
Overview & Management Protocol
+Objectives
Understand the action of insulin on the body
Understand the mechanism of DKA and why it happens
Understand the management protocol for DKA
Understand the complications of DKA management
+What is it?
An acute complication of Diabetes
A state of absolute or relative insulin deficiency
Treatment for DKA has to be done by a trained specialist
Constant monitoring of the patient is required to avoid development of complications
Transfer patients to resuscitation if, Patient develops coma or impaired consciousness Hemodynamic instability pH <7.1 and HCO3
- <5
K+ >6.5 or <3
+Complication Cause
Hypoglycemia Over administration of insulin (High dose regimen 1U/Kg)
Hypokalemia Secondary to high dose regimen insulin (1U/Kg) and HCO3
-
Hyperglycemia Discontinuation/ interruption to insulin treatment
Hyperchloremia Excessive saline administration
Cerebral Edema Most fatal Possible contributors:
hypoxia movement of water into the CNS with rapid fall in
plasma osmolality effect of insulin on the plasma membrane of brain
cells, which may promote cellular edema
Fluid Overload Patients with cardiac failure or renal insufficiency may develop CHF
ARDS Due to Pulmonary edema
Thromboembolism
Enhancement of the hypercoagulable state of a DM patient
+Summery
DKA is a common complication that will be met in any ER
DKA can be easily diagnosed by asking the right questions and catching the right signs
DKA can be easily managed if the protocol for management is followed correctly
Complications can be avoided by making sure a trained specialist is present and monitoring is done correctly.
+References
Michelle A. Charfen, MD, Madonna Fernandez-Frackelton, MD, FACEP. Diabetic Ketoacidosis. Emerg Med Clin N Am 23 (2005) 609–628
Faiza A. Qari, FRCP, ABIM. Precipitating Factors for Diabetic Ketoacidosis. Saudi Med J 2002; Vol. 23 (2).
M. W. Savage, et al. Diabetes UK Position Statements and Care Recommendations, Joint British Diabetes Societies guideline for the Management of Diabetic Ketoacidosis. Diabetic Medicine, 2011.
Dr, Hani Ibrahim, Dr. Anwar Jammah. DKA Protocol. KKUH department of Emergency Medicine.