Diabetic Ketoacidosis Management

Posted by e-Medical PPT Saturday, August 14, 2010
The main aims in the treatment of diabetic ketoacidosis are replacing the lost fluids and electrolytes while suppressing the high blood sugars and ketone production with insulin. Admission to an intensive care unit for close observation may be necessary.The amount of fluid depends on the estimated degree of dehydration. If dehydration is so severe as to cause shock, or a depressed level of consciousness, rapid infusion of saline (1 liter for adults, 10 ml/kg in repeated doses for children) is recommended to restore circulating volume.Very mild ketoacidosis with no associated vomiting and mild dehydration may be treated with oral rehydration.In general, insulin is given at 0.1 unit/kg per hour to reduce the blood sugars and suppress ketone production. This can be administered immediately after the potassium level is known to be higher than 3.3 mmol/l.Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells.The administration of sodium bicarbonate solution to rapidly improve the acid levels in the blood.The ideal treatment of cerebral edema in DKA is not established, but intravenous mannitol and hypertonic saline (3%) are used.

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