Discharge Teaching For Patient With Dka

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Diabetic Ketoacidosistreatment & Management

Diabetic KetoacidosisTreatment & Management Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of fluid loss with intravenous fluids Correction of electrolyte disturbances, particularly potassium loss Treatment of concurrent infection, if present It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis . It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and acidosis. Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost. Patients usually are not discharged from the hospital unless they have been able to switch back to their Continue reading >>

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  1. ScrillaKeith

    Re-entering Carb Diet after CKD

    I've read a few different views on how to reintroduce carbs after being on a ketogenic diet. What I would like to discuss is the ways to do it
    a) after a short (3-6 week) CKD bout, and
    b) after a longer stint (12 weeks+)
    I'm pretty well versed in diet and nutrition, but this has been my first time actually trying a ketogenic diet (CKD) myself and would like to hear feedback from the more experienced keto gurus.
    I found this on John Berardi's site, but I'm assuming that's playing it extra safe after only a few weeks of keto.

    Originally Posted by John Berardi
    Coming off of a ketogenic diet
    Q: I've been following a ketogenic diet for nearly a year now. I would love to come off the diet because it has killed my sex drive and my progress in the gym has all but halted. I lost a good amount of fat on it for the first couple of months, but then my progress stopped. The problem is that when I try to go off the diet and eat normally again, I blow up. Help!
    A: Buddy, you're not alone. Although the ketogenic diet works very well for some individuals, the majority of weight trainers have the same problems that you mentioned. But they're too afraid to go off the diet because it appears that they'll rapidly gain back a lot of fat and end up where they started. And they're too afraid to get help. Remember the old saying� the first step toward getting help is admitting you have a problem.
    There are several reasons why people blow up and gain a lot of weight when trying to come off ketogenic diets. They include:
    Carbohydrate intolerance: While on a ketogenic diet, the body becomes more efficient at using fat for energy and therefore "forgets" how to process carbohydrates. So for a few weeks after you start eating normally again, you'll be storing those carbs and getting fatter. Sure, a lot of it will go to muscle glycogen, but a much larger amount than expected will go to fat stores. It takes a few weeks for the body to "remember" how to process carbohydrates.
    Insulin Resistance: Ketogenic diets decrease insulin sensitivity. In fact, in people coming off ketogenic diets, the symptoms are similar to those seen in type-2 diabetics! The likelihood of gaining fat due to this insulin resistance is high.
    Stimulants: Most dieters abuse caffeine and ephedrine. Both of these substances decrease insulin sensitivity as well and can induce diabetic like symptoms when reintroducing carbohydrates into the body.
    Water Gain: Ketogenic diets, because of their effects on fluid balance, can induce mild dehydration. Although this makes you look lean and "dry", it negatively impacts performance. Once you start eating normally again, the body hyperhydrates, causing massive water retention. Although sometimes uncomfortable, this typically leads to big gains in strength in the gym. However, all this water retention does make the physique "blurry." So most people mistake this water gain for fat gain. Unless you have body fat measures done regularly, it'll be hard to know whether it's fat or water.
    So now that you know why you blow up, let me tell you how to avoid it:
    The first step is to plan a flexible 6-week transition period in which you'll taper off the ketogenic diet. The most effective way to transition here is to use the insulin and carbohydrate sensitivity measures discussed in part 2 of my Massive Eating Article. Now listen up� this is important. During this time you'll be supplementing with insulin sensitizing supplements. I recommend 600 mg of alpha-lipoic acid per day, lots of fish oils (at least 6g of DHA and EPA), glucosol (colosolic acid) at about 50 mg per day, and inzitol (d-pintol) at about 50 mg per day. Remember to take the ALA, glucosol, and inzitol during separate carbohydrate meals. Don't take them with a carbohydrate free meal or together. In addition, do your cardio. About 30 min 4x per week, separate from weight training, does wonders for increasing insulin sensitivity and carbohydrate tolerance.
    Have an OGTT and a fasted blood insulin and glucose sample taken at the beginning of the transition week (again, see part 2 of the Massive Eating Article).
    During weeks 1 and 2, gradually reintroduce carbohydrates into the diet. Try replacing 10% of your fat with high fiber, low glycemic and insulin index carbohydrates (if your diet is 60% fat, 40% protein change it to 50% fat, 40% protein, 10% carbohydrate). Some good carbohydrate sources are oatmeal, vegetables, nuts, beans, and fruits. This is easier said than done, though, because most often, when reintroducing carbohydrates into the diet, carbohydrate cravings go through the roof! So be prepared and be strong.
    At the start of week 2, have another OGTT and a fasted blood insulin and glucose sample taken. Your insulin sensitivity should be improved due to the supplementation. If not, stay on 10% carbohydrate 'till it is.
    For weeks 3 and 4, decrease your fat intake and increase your carbohydrate intake to about 20% of the diet, again using high fiber, low GI and II carbohydrates (now you will be at 40%fat, 40% protein, 20% carbohydrate). Follow this for 2 weeks while remaining on the recommended supplements.
    Again, at the start of week 4, have another OGTT and a fasted blood insulin and glucose sample taken. Your insulin sensitivity should be improved due to the supplementation. If not, stay on 20% carbohydrate 'till it is.
    For weeks 5 and 6, decrease your fat intake and increase your carbohydrate intake to about 30% of the diet, again using high fiber, low GI and II carbohydrates (now you will be at 30% fat, 40% protein, 30% carbohydrate). Once you get to this point, you should be home free.
    So will this approach prevent all fat gain? No, but it will definitely minimize it. Just keep in mind that you'll probably gain some water and that this is a good thing. But this water does scare most people as they mistake it for fat gain. Just hang in there and the body will normalize over the 6-week period and you'll end up just fine.
    Remember, this program requires a lot of effort and discipline, but it's very effective. Don't waste a year of dieting by indiscriminately changing your eating plan. You'll only get fat and/or frustrated. Or you'll never go off the diet that's making you unhappy.

    Any input appreciated!

  2. johnnyironboard

    Don't eat flour and sugar and limit starches. Donuts,frosted flakes, and french fries are an invitation to disaster.

  3. ScrillaKeith

    Here is an example of a different approach I am thinking of:
    Weeks 1-2: Carbs only on workout days: ~50g complex carbs pre-workout
    and 50-100g simple carbs post-workout.
    Weeks 2-4: Same as week one but 50-100g carbs/day depending on
    bodyweight and carb intake during keto diet, but around .5g/lb
    of bodyweight) on non-workout days
    Weeks 4-6: Upping carb intake anywhere from 50g carbs a day to 1.5g/lb
    Weeks 6+: Continue above until carb ratio that is most effective for the
    individual is reached.
    This way energy levels and fat/muscle gains could be monitored every 2 weeks to get back to a higher level of carbs (35-60%), while letting the body readjust to using glycogen for fuel.
    Has anyone tried an approach similar to this? I just pulled it off the top of my head so obviously some adjustments could be made...

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes mellitus. DKA is characterized by the triad of hyperglycemia, anion gap metabolic acidosis, and ketonemia. It is part of a spectrum of hyperglycemia on which lies hyperosmolar hyperglycemic state (HHS). Though the two are distinct entities, they do share some commonalities. DKA is caused by the reduced effect of insulin, either due to deficit or reduction of levels, with concomitant elevation of counter regulatory hormones (glucagon, catecholamines, cortisol, and growth hormones), generally due to a precipitating stress. Increased gluconeogenesis, glycogenolysis, and decreased glucose uptake by cells leads to hyperglycemia, while insulin deficiency leads to mobilization and oxidization of fatty acids leading to ketogenesis. Although DKA may be the initial manifestation of diabetes, it is typically precipitated by other factors. It is critical for a clinician to identify and treat these factors. Infection can be found in 40-50% of patients with hyperglycemic crisis, with urinary tract infection and pneumonia accounting for the majority of cases. DKA is a life-threatening medical emergency with a mor Continue reading >>

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  1. spblind

    I've googled and there are so many different answers, i don't know which to believe !

  2. rundymc

    When you're breath stinks more than usual.

  3. spblind

    rundymc wrote:
    When you're breath stinks more than usual. i don't feel it leh, i've been on a keto diet for a week, 65% of fats intake and 35% of protein 0% carbs.
    but my urine become damn yellow and the smell of fats oil, very bubbly and thick also and of cos the first few days i felt very giddy and i don't even feel like doing anything, like crashing like that but now better alot alr.

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Diabetic Ketoacidosis Discharge Instructions

Diabetic Ketoacidosis Discharge Instructions Diabetic ketoacidosis is a serious problem. It may happen when you have high blood sugar and you dont treat it. Your body needs insulin. This controls the amount of sugar in your blood. The food we eat contains sugar. Insulin changes this sugar into energy which is needed by your body. If you do not have the right amount of insulin in your body, it will use fats for energy instead of sugar. Ketones are made after the fat is used for energy. If you continue to not have enough sugar, then more and more ketones will be made. Ketones are an acid that will increase in your blood and show up in your urine. Ketones poison your body. This leads to diabetic ketoacidosis. Doctors treat this illness in the hospital by replacing the lost fluids and minerals. They will also give you insulin so your body can use sugar for energy. Ask your doctor what you need to do when you go home. Make sure you understand everything the doctor says. This way you will know what you need to do. Learn how to take your own blood sugar and check ketone levels in your urine. Ask your doctor about home kits. The doctor may want you to use test strips to check your urine f Continue reading >>

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  1. launchpad

    can anyone plz tell me what happens to the Na and K levels in DKA.kaplan says there is hypernatremia and hypokalemia.

  2. frontal

    There is no hypernatremia in DKA. There is electrolyte loss in DKA primariy due to hyperglycemia causing osmotic diuresis, so the patient is depleted of both Na and K, but the serum levels of potassium maybe normal or even elevated. This is because of a disproportionate loss of water (osmotic diuresis) and because of acidosis, which forces the hydrogen ions into cells in exchange for K ions. Remember: a patient with DKA is potassium depleted, even if serum potassium values are on the higher side at presentation. Renal loss continues and as treatment with insulin is started, a fall in serum potassium is likely to be observed because insulin pushes the K ions back into the cells. Electrolye monitoring is necessary while treating the patient, so that insulin dose can be adjusted and fluids given appropriately.

  3. frontal

    A normal serum sodium level in DKA would indicate profound dehydration.

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