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Dka Algorithm

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http://www.etch.com/articles/claytons... - Since the age of five, Clayton Ailshie has been living with Juvenile Diabetes. After noticing early warning signs, Clayton's parents were referred to East Tennessee Children's Hospital. Today, with help from the doctors and nurses at Children's Hospital, Clayton lives a fun, active life.

Updated Feb 2017 J Clayton

NUH Management of Diabetic Ketoacidosis in Adults (18 years old & over) (Please see the Paediatric guidelines for patients under 18 years) If in doubt, call someone more senior. KETOACIDOSIS CAN KILL. Use in conjunction with the NUH pathway of care for DKA in adults (insulin prescription, administration and monitoring chart). 1. DIAGNOSIS All three required 1. Raised blood glucose>11mmol /L or known diabetes 2. Capillary ketones > 3 mmol/L (or Ketones >2+ in urine) 3. Venous pH < 7.35 or venous bicarb < 15mmol/L 2. ESSENTIAL INVESTIGATIONS Arterial puncture NOT routinely needed ï‚· U+E, creatinine, blood glucose ï‚· Venous blood gas for bicarbonate, potassium and pH (analyse on machine on B3, ED, HDU, ITU) ï‚· ECG/CXR/MSU/blood cultures/pregnancy test depending on clinical suspicion Raised WCC and serum amylase are common in DKA and do not usually suggest pancreatitis. 4. IMMEDIATE TREATMENT START IN EMERGENCY DEPT / ASSESSMENT UNIT OR THEIR CURRENT LOCATION. DELAY IN STARTING TREATMENT MAY BE FATAL. 1. Insert venflon 2. 1L 0.9% sodium chloride infusion over 1hr if systolic BP>90 (If systolic BP<90 give repeated boluses of 500ml 0.9% sodium chloride over 10-15 minutes) Continue reading >>

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Popular Questions

  1. Porthardygurl

    I am feeling rather upset and concerned right now at this time. I have been OP since i started this program this time around..Not a lick , taste or a bite and my numbers show the continuous losses from week to week..I have been so happy being in ketosis and not feeling hungry...
    HOWEVER... I was feeling seriously nauseated in the store today, felt like i was going to puke...so my hubby grabbed me a 1 litre gingerale and we booked it out of there pronto...I get to the car, unscrew the cap and suck it back like nobodys business...hoping that it would help..Well..good news is..it did help... BAD NEWS is... It wasnt diet ...
    I didnt even look at the label on the bottle till after i had drank some..Usually i pick up diet .... i never buy the sugar laden soft drinks..but my hunny must have picked it up in a rush, and didnt look..and of course me thinking that he has my best interest at heart..assumed it was diet....
    So now im seriously conerned i have knocked myself out of ketosis...
    The carb content per 8oz were 25 grams of carbs... 16 grams of sugar...
    I measured the rest of the gingerale out when i got home to see how much i had drank..and it looks like maybe 1/2 a cup was gone..My question is...if thats half a cup...then thats about 13 total carbs for that 1/2 cup....
    My other food for the day..has consisted of..
    morning shake: 2 g net carb
    Lunch shake : 2 g net carb
    wafer packet alternative: 6 net carb
    So thats 10 grams of Net carbs without adding in vegs yet...So 10 plus 12 is 22 Net carbs...will this kick me out of ketosis????? Ive worked so hard to stay OP 100% I dont want to have ruined it...

  2. CarCamMom

    Quote:

    Originally Posted by Porthardygurl
    I am feeling rather upset and concerned right now at this time. I have been OP since i started this program this time around..Not a lick , taste or a bite and my numbers show the continuous losses from week to week..I have been so happy being in ketosis and not feeling hungry...
    HOWEVER... I was feeling seriously nauseated in the store today, felt like i was going to puke...so my hubby grabbed me a 1 litre gingerale and we booked it out of there pronto...I get to the car, unscrew the cap and suck it back like nobodys business...hoping that it would help..Well..good news is..it did help... BAD NEWS is... It wasnt diet ...
    I didnt even look at the label on the bottle till after i had drank some..Usually i pick up diet .... i never buy the sugar laden soft drinks..but my hunny must have picked it up in a rush, and didnt look..and of course me thinking that he has my best interest at heart..assumed it was diet....
    So now im seriously conerned i have knocked myself out of ketosis...
    The carb content per 8oz were 25 grams of carbs... 16 grams of sugar...
    I measured the rest of the gingerale out when i got home to see how much i had drank..and it looks like maybe 1/2 a cup was gone..My question is...if thats half a cup...then thats about 13 total carbs for that 1/2 cup....
    My other food for the day..has consisted of..
    morning shake: 2 g net carb
    Lunch shake : 2 g net carb
    wafer packet alternative: 6 net carb
    So thats 10 grams of Net carbs without adding in vegs yet...So 10 plus 12 is 22 Net carbs...will this kick me out of ketosis????? Ive worked so hard to stay OP 100% I dont want to have ruined it... I wish I could help you, but I'm too new to be sure....All I can do is hope for you!! I think the magic number I hear is 40 carbs or less a day, so you might be ok???? I'm sure someone else will know. I've got my fingers crossed for you!
    Look on the bright side...this will make for an excellent update on IPTV!

  3. scorbett1103

    I'm way too new to be an expert, but I've done LOTS of reading on the forums since starting. I have seen more than one person post that their coach allowed for a "cheat" day (which I can only assume means they would be eating a lot more carbs than usual) followed by 2 days on VERY strict phase 1 protocol with NO restricted packets/bars. Not something to make a habit of, but it might be worth doing for the next 2 days and talk to your coach. You might stall just a little but you shouldn't lose too much ground.

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Sarasota Memorial Diabetes Educators discuss the ABC's of diabetes management and the benefits a simple class can offer to help people living with diabetes. For more information, visit smh.com or call Sarasota Memorial's HealthLine at (941) 917-7777.

Smh Dka Protocol

Insulin Drip protocol for DKA Purpose: Quick/Safe management of the patient in DKA Method: Evidence based approach using a standardized protocol. Outcomes: Patient will have complete recovery from DKA episode and be discharged in a safe and timely manner. History at SMH The DKA protocol has been used in the: Renal, Diabetic, Wound Unit (7wt) for 2 years ICU for 1 year ECC for 6 months It was developed by a team lead by Dr. Antunes, Pharmacy, the Certified Diabetic Educator on 7wt and the Clinical Manager on 7wt . The Protocol is evidence based.* Procedure When your patient comes into the ECC the ECC MD may have already initiated the ECC DKA Protocol. When the patient reaches 7wt/ICU it will be discontinued and converted to the inpatient DKA protocol . To continue the protocol just add †DKA Protocol†to your orders, the patient will be on algorithm 2 from the ECC. If you are initiating then please specify which algorithm to start the protocol on 1 or 2. Once the patient is stabilized we will need orders for long acting insulin , short acting sliding scale insulin and a diet order. We like to keep patient on clear liquids until we can get blood sugar and CO2 in a safe range. Continue reading >>

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Popular Questions

  1. Aaron1963

    Peter Attia on people who don't do well on a Ketogenic Diet

    I know there's a few people around here who don't do well on a ketogenic diet. I know for myself, who does extremely well with this way of eating, it's sometimes hard to understand why it doesn't work for everyone. And I think sometimes the people who it doesn't work well for get exasperated with all the talk of LCHF and ketogenic diets. Well, Peter Attia, who I have a lot of respect for, talks some in this podcast about how there are some people who just don't do well on a ketogenic diet. I don't know if it would be of any interest for those of you who have this problem or not:
    http://timferriss.libsyn.com/ep-65-s...dr-peter-attia
    He doesn't go into a lot of detail about it, but it's more that it's just interesting that there is a minority of people who do have this problem.

  2. furball64801

    Its amazing how all things do not work well for everyone. Ah the saying none of us is exactly alike. I did real well on a low carb diet when I was 25 only wanted to lose about 15 lbs then, was not diabetic had energy coming out my ears. Tried it 20 yrs later and did not change my numbers that much, yes better but not to normal. I hear from some weight falls right off them and numbers turn to normal, nice if you can get it maybe pancreas function should be measured who knows why or what causes this.

  3. Aaron1963

    Just to be clear, this wasn't in relation to diabetes, but people in general who want to go on a ketogenic diet but apparently have problems with eating all that fat.

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This is my story when I was in DKA in the ICU. I made this video in honor of all T1D gone too soon. Also to be a video one may view when a loved one is experiencing DKA or first getting diagnosed. Also for any T1D out there who may be experiencing DKA for the first time. Early detection is key!

Dka Without The Icu

As we discussed yesterday, the treatment algorithm for DKA is fairly straightforward with a few subtleties we rarely appreciate, until now. Yesterday we focused on fluids, today we move on to the insulin. Can we offer the patient anything else beside an insulin drip? Obviously the answer is yes, or else this pearl wouldn’t exist. In 2004, Umpierrez et al conducted an RCT of 20 patients comparing subcutaneous lispro (0.3U/kg bolus followed by 0.1U/kg/h) vs. an IV insulin (0.1 u/kg bolus followed by 0.1 U/kg/h drip). They found that there was no difference in time to correction of hyperglycemia, time to resolution of DKA, length of hospital stay, or rates of hypoglycemia. Later that year, they conducted a second study of 45 patients comparing doses of 0.1U/kg/h subcutaneous insulin to 0.2U/kg/h subcutaneous insulin to standard therapy. Not surprisingly, they showed that no protocol was more efficacious than another, however they did show a 39% high hospitalization charges in the IV insulin group due to the ICU setting necessary to manage the insulin drip. Since then the Cochrane collaborative has addressed the same question. They reviewed 5 trials including 201 total patients (some Continue reading >>

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Popular Questions

  1. Santosh Anand

    Insulin plays a key role in helping sugar (glucose) enter your cells, thus providing them energy. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acidic and so when they build up in the blood, they make the blood more acidic, leading to the condition called diabetic ketoacidosis (DKA).
    Now, in type-1 diabetes, there is no insulin production whereas in type-2, there is impairment of insulin production. Thus why Type-2 diabetic people hardly get DKA.
    Note: Diabetic ketoacidosis is a serious condition that might lead to diabetic coma or even death.

  2. Lucas Verhelst

    In order for the cells in your body to access the glucose in your bloodstream so they can use it as energy they need insulin. Insulin acts like a key, opennin the cell door to allow the entry of glucose. Type 1 diabetics produce no insulin and need to inject it, thus the amount of insulin they have is strictly limited. Once they run out of insulin the glucose remains in the blood stream. If this occurs over a long period of time their blood glucose levels will rise due to the release of glucose from the liver. High blood sugar levels causes ketoacidosis which leads to coma and death.

  3. Keith Phillips

    Although type 2 diabetics suffer from insulin resistance, the condition rarely has an absolute negative effect on the bodies ability to convert glucose to usable energy. Type 1 diabetics have little or no ability to produce insulin. With the exception of neural cells, the rest of the body which without insulin is experiencing starvation, will consume its own tissues. (this is how people have endured periods of famine). This process however produces by products that eventually overwhelm the body's ability to process toxins.

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