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Dka Diagnosis Criteria Uk

Learning From Practice

Learning From Practice

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go? WINSTON CRASTO,1 ZIN ZIN HTIKE,2 LISA TURNER,3 KATH HIGGINS4 Abstract Background: The Joint British Diabetes Society (JBDS) consensus guideline published in 2010 has provided the framework for the effective management of diabetic ketoacidosis (DKA) in adults in the UK. Methodology: A retrospective study of 50 patient episodes admitted to our teaching hospital between February and December 2012, with a discharge diagnosis of DKA. Results: Twenty-seven (54%) patients were male, mean (SD) age was 43 (21) years and duration of diabetes was 11 (9) years. In the first 60 minutes from diagnosis, median (interquartile range [IQR]) time to fixed rate intravenous insulin infusion (FRIII) was 49 (29–110) minutes and to in- travenous fluids was 19 (0–42) minutes. During ongoing management, 46% of patients developed hypokalaemia and, of those, in 70% potassium supplementation was not prescribed as per protocol. Forty percent of patients expe- rienced hypoglycaemia in the first 24 hours, of whom 80% had 10% dextrose prescribed appropriately according to protocol. Median time to hypoglycaemia from diagnosis was 12 hours 54 minutes. Median (SD) time to resolution of DKA was 12 hours 6 minutes. Eighty six percent of patients were reviewed by the diabetes specialist team during admission. No deaths due to DKA or complications of its management were reported. Median length of hos- pital stay was two days. Conclusions: Adherence to the JBDS DKA guideline was good in the immediate stage of treatment. Inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern. A high propor- tion of patients received diabetes speci Continue reading >>

Updated Feb 2017 J Clayton

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  U+E, creatinine, blood glucose  Venous blood gas for bicarbonate, potassium and pH (analyse on machine on B3, ED, HDU, ITU)  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) 3. Start IV insulin infusion: 50 units human soluble (ACTRAPID®) insulin added to 49.5 mls 0.9% sodium chloride to give a 1 unit/ml solution via syringe driver at 0.1 units/ kg / hr (estimated or actual weight) 3. SEVERITY (Venous bicarbonate or pH) >14 mmol/l or pH >7.3 Mild 10-14 mmol/l or pH 7.1-7.3 Moderate < 10 mmol/l or pH <7.1 Severe 5. TRANSFER NO PATIENT WITH DKA SHOULD BE TRANSFERRED BETWEEN HOSPITALS URGENT CRITICAL CARE/HDU REVIEW if any of: Venous bicarbonate < 10 mmol/l or pH<7.1, drowsy (P or U on AVPU), fluid balance problems, pregnancy, co morbidities, sats<94% on 40% O2, p Continue reading >>

Joint British Diabetes Societies (jbds) For Inpatient Care Group

Joint British Diabetes Societies (jbds) For Inpatient Care Group

The Joint British Diabetes Societies (JBDS) for Inpatient Care group was created in 2008 to ‘deliver a set of diabetes inpatient guidelines and proposed standards of care within secondary care organisations’, with the overall aim of improving inpatient diabetes care through the development and use of high quality evidence based guidelines, and through better inpatient care pathways. The JBDS – IP group was created and supported by Diabetes UK, ABCD and the Diabetes Inpatient Specialist Nurse (DISN) UK group, and works with NHS England, TREND-UK and with other professional organisations. The 2017 Rowan Hillson Inpatient safety award For information about this click here Guidelines The guidelines produced by the JBDS – IP group (including those planned for the future) are listed below and for those already published click the live link on the date to view: No Guideline Date 1 Hospital management of hypoglycaemia in adults with diabetes March 2010 1a Hospital management of hypoglycaemia in adults with diabetes - revised - second edition 2013 Sept. 2013 2 The management of diabetic ketoacidosis (DKA) in adults March 2010 2a The management of diabetic ketoacidosis (DKA) in adults - revised - second edition 2013 Sept. 2013 2b Adult diabetic ketoacidosis emergency care pathway to use in the case notes - accompanies the DKA revised guideline 2013 Sept. 2013 2c JBDS DKA condensed management charts accompanies the DKA revised guideline 2013 August 2017 3 Management of adults with diabetes undergoing surgery March 2011a March 2011b 3a Management of adults with diabetes undergoing surgery – full document March 2016 3b Management of adults with diabetes undergoing surgery - summary March 2016 3c Management of adults with diabetes undergoing surgery – changes to 2011 guid Continue reading >>

The Cost Of Treating Diabetic Ketoacidosis In The Uk: A National Survey Of Hospital Resource Use

The Cost Of Treating Diabetic Ketoacidosis In The Uk: A National Survey Of Hospital Resource Use

Abstract Diabetic ketoacidosis is a commonly encountered metabolic emergency. In 2014, a national survey was conducted looking at the management of diabetic ketoacidosis in adult patients across the UK. The survey reported the clinical management of individual patients as well as institutional factors that teams felt were important in helping to deliver that care. However, the costs of treating diabetic ketoacidosis were not reported. We used a ‘bottom up’ approach to cost analysis to determine the total expense associated with treating diabetic ketoacidosis in a mixed population sample. The data were derived from the source data from the national UK survey of 283 individual patients collected via questionnaires sent to hospitals across the country. Because the initial survey collection tool was not designed with a health economic model in mind, several assumptions were made when analysing the data. The mean and median time in hospital was 5.6 and 2.7 days respectively. Based on the individual patient data and using the Joint British Diabetes Societies Inpatient Care Group guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £2064 per patient (95% confidence intervals: 1800, 2563). Despite relatively short stays in hospital, costs for managing episodes of diabetic ketoacidosis in adults were relatively high. Assumptions made in the calculations did not consider prolonged hospital stay due to comorbidities or costs incurred as a loss of productivity. Therefore, the actual costs to the healthcare system and society in general are likely to be substantially higher. What's new? Diabetic ketoacidosis is a commonly encountered metabolic emergency, but the costs of treating the condition remain unknown in t Continue reading >>

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

CURRENT TOPICS The management of the hyperosmolar hyperglycaemic state in adults with diabetes: a summary of a report from the Joint British Diabetes Societies for Inpatient Care AR SCOTT1 ON BEHALF OF THE JOINT BRITISH DIABETES SOCIETIES FOR INPATIENT CARE2 AND THE Abstract The Joint British Diabetes Societies for Inpatient Care have recently provided guidance on the management of hyper- osmolar hyperglycaemic state (HHS), a medical emergency which differs from diabetic ketoacidosis (DKA) through higher mortality and potential for complication by my- ocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis (the latter possibly precipi- tated by rapid changes in osmolality during treatment). DKA presents within hours of onset, whereas HHS devel- ops over many days, and its associated dehydration and metabolic disturbances are more extreme. A different therapeutic approach is required for HHS than for DKA. The key points in these guidelines are: Monitoring of the response to treatment: • Measure or calculate serum osmolality regularly to monitor the response to treatment • Aim to reduce osmolality by 3–8 mOsm/kg/h Fluid and insulin administration: • Use intravenous 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration • Note that fluid replacement alone will cause a fall in blood glucose; withhold insulin until blood glucose is no longer falling with intravenous fluids alone (unless ketonaemic) • An initial rise in sodium is expected and is not itself an indication for hypotonic fluids • Early use of insulin (before fluids) may be detrimental Delivery of care: • Involve the diabetes specialist team as soon as possible. • Nurse patient Continue reading >>

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

Maturity Onset Diabetes of the Young (MODY) accounts for upto 2% of all patients with diabetes. Hepatocyte Nuclear Factor 1 alpha (HNF1-A) MODY is the most common subtype accounting for 30–70% of all MODY cases. Typically, it presents in young adults below the age of 45, frequently < 25 with autosomal dominant family history of diabetes, absence of autoimmune markers and insulin resistance and c-peptide positivity. DKA is a rare complication of MODY particularly in situations of non-compliance. We describe a case of DKA in a genetically confirmed HNF1-A MODY patient presented to our hospital. A 26-year-old female was admitted with severe vomiting. She had a background history of HNF1- alpha MODY diagnosed at the age of 15 when she was found to have hyperglycaemia during pregnancy. She was on Gliclazide 40mg daily but stopped taking it about a year ago. Her pH was 6.96, blood glucose of 31.4 mmol/L and blood Ketones of 5.8 mmol/L. This was consistent with DKA which was successfully treated. There was no evidence of sepsis. Her HbA1c was high at 101mmol/mol suggesting poor glycaemic control. She had uneventful recovery and was discharged home on Gliclazide with appropriate follow up arranged. The presence of DKA was previously considered an exclusion criterion for MODY according to the International Society for Paediatrics and Adolescent Diabetes (IPSAD) 2009 guidelines. It is presumed that patients with MODY do not develop DKA due to the presence of residual insulin production that prevents ketogenesis. However, this was withdrawn in the 2014 update due to several case reports of DKA in confirmed MODY patients. The majority of patients with genetically proven MODY are initially incorrectly diagnosed as Type 1 or Type 2 diabetes. Exclusion of DKA from the diagnostic cri Continue reading >>

Management Of Diabetic Ketoacidosis (dka)

Management Of Diabetic Ketoacidosis (dka)

Management of Acute Diabetic Ketoacidosis (DKA) Below is the link to the care pathway for the management of diabetic ketoacidosis in adults. Specific guidelines exist for the management of DKA in children. In patients aged 13-16 years presenting with DKA, the management of DKA should be discussed with relevant paediatric staff. Diagnosis Severe uncontrolled diabetes with: Hyperglycaemia (blood glucose >14mmol/L, usually but not exclusively) Metabolic acidosis (H+ >45mEq/L or HCO3- <18mmol/L or pH <7.3 on venous gases) Ketonaemia (>3mmol/L) / ketonuria (>++) Severity criteria One or more of the following may indicate severe DKA and should be considered for level 2 care (MHDU if available). It may also be necessary to consider a surgical cause for the deterioration. Blood ketones >6mmol/L Bicarbonate level <5mmol/L Venous / artierial pH <7.1 Hypokalaemia on admission (<3.5mmol/L) GCS <12 or abnormal AVPU scale Oxygen saturation <92% on air (assuming normal baseline respiratory function) Systolic BP <90mmHg, pulse >100bpm or <60bpm Anion gap >16 [anion gap = (Na+ + K+) – (Cl- + HCO3-)] Cerebral oedema The care pathways for the emergency management of DKA should be used for all eligible patients. Complete pathways for 0–4 hours and 4 hours–discharge for each DKA episode. These provide instruction on fluid balance, insulin and potassium replacement. Please note there are DKA order sets on TrakCare (DKA baseline and DKA continuing care). The care pathways are available within relevant departments or online at NHSGGC Managed Clinical Networks / Diabetes MCN / Clinical Guidelines and Protocols / DKA Care Pathway. Supplementary notes as per care pathway 0–4 hours Continue background SC insulin (glargine, levemir, degludec, isophane insulin) while on fixed rate intravenou Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management – Nice Guideline (update)

Type 1 Diabetes In Adults: Diagnosis And Management – Nice Guideline (update)

This National Institute for Health and Care Excellence (NICE) guideline covers the care and treatment of adults (aged 18 and over) with type 1 diabetes. Education and information Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis. [new 2015] Blood glucose management Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the risk of long‑term vascular complications. [new 2015] Agree an individualised HbA1c target with each adult with type 1 diabetes, taking into account factors such as the person's daily activities, aspirations, likelihood of complications, comorbidities, occupation and history of hypoglycaemia. [new 2015] Support adults with type 1 diabetes to test at least four times a day, and up to 10 times a day if any of the following apply: desired target for blood glucose control, measured by HbA1c level, is not achieved frequency of hypoglycaemic episodes increases legal requirement to do so (such as before driving, in line with the Driver and Vehicle Licensing Agency (DVLA) during periods of illness before, during and after sport when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy) if there is a need to know blood glucose levels more than four times a day for other reasons (for example, impaired awareness of hypoglycaemia, high‑risk activities). [new 2015] Advise adults with type 1 diabetes to aim for: fasting plasma glucose level of 5–7 mmol/litre on waking plasma glucose level of 4–7 mmol/litre before meals at other times of the day. [new 2015] Insulin therapy Offer multiple da Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Abstract Background: The Joint British Diabetes Society (JBDS) consensus guideline published in 2010 has provided the framework for the effective management of diabetic ketoacidosis (DKA) in adults in the UK. Methodology: A retrospective study of 50 patient episodes admitted to our teaching hospital between February and December 2012, with a discharge diagnosis of DKA. Results: Twenty-seven (54%) patients were male, mean (SD) age was 43 (21) years and duration of diabetes was 11 (9) years. In the first 60 minutes from diagnosis, median (interquartile range [IQR]) time to fixed rate intravenous insulin infusion (FRIII) was 49 (29–110) minutes and to intravenous fluids was 19 (0–42) minutes. During ongoing management, 46% of patients developed hypokalaemia and, of those, in 70% potassium supplementation was not prescribed as per protocol. Forty percent of patients experienced hypoglycaemia in the first 24 hours, of whom 80% had 10% dextrose prescribed appropriately according to protocol. Median time to hypoglycaemia from diagnosis was 12 hours 54 minutes. Median (SD) time to resolution of DKA was 12 hours 6 minutes. Eighty six percent of patients were reviewed by the diabetes specialist team during admission. No deaths due to DKA or complications of its management were reported. Median length of hospital stay was two days. Conclusions: Adherence to the JBDS DKA guideline was good in the immediate stage of treatment. Inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern. A high proportion of patients received diabetes specialist nurse input with reduced length of stay and no recorded mortality. Our recommendations as a result of this audit include a strengthened programme of teaching and education for nursing and medical Continue reading >>

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) (ii) (iii) This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management

Type 1 Diabetes In Adults: Diagnosis And Management

High blood glucose (hyperglycaemia) that is not treated can lead to a serious condition called diabetic ketoacidosis (or DKA for short). It is caused by the build‑up of harmful ketones in the blood. People with type 1 diabetes are at risk of DKA. You may be advised to test for ketones in your blood or urine as part of sick-day rules. Your blood ketones may be measured by a healthcare professional if it is thought you might have DKA. If you have DKA you will need emergency treatment in hospital by a specialist care team. This will include having fluids through a drip. Questions to ask about DKA Continue reading >>

Sglt2 Inhibitors: Updated Advice On The Risk Of Diabetic Ketoacidosis

Sglt2 Inhibitors: Updated Advice On The Risk Of Diabetic Ketoacidosis

Advice for healthcare professionals: When treating patients who are taking a sodium-glucose co-transporter 2 (SGLT2) inhibitor (canagliflozin, dapagliflozin, or empagliflozin): inform them of the signs and symptoms of diabetic ketoacidosis (DKA) – see below – and advise them to seek immediate medical advice if they develop any of these discuss the risk factors for DKA with patients (see below) discontinue treatment with the SGLT2 inhibitor immediately if DKA is suspected or diagnosed do not restart treatment with any SGLT2 inhibitor in patients who experienced DKA during use, unless another cause for DKA was identified and resolved interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised Reports of diabetic acidosis EU medicines regulators have completed a review of DKA associated with SGLT2 inhibitor treatment; this article summarises the review’s recommendations. We published preliminary advice on this in June 2015. SGLT2 inhibitors are licensed for use in adults with type 2 diabetes to improve glycaemic control. Serious, life-threatening, and fatal cases of DKA have been reported in patients taking an SGLT2 inhibitor (canagliflozin, dapagliflozin, or empagliflozin). The EU review concluded that this side effect is rare (affecting between 1 in 1000 and 1 in 10,000 patients). Up to 26 February 2016, we had received 118 Yellow Card reports of DKA and associated reactions in patients taking an SGLT2 inhibitor in the UK. In several cases, blood glucose levels were only moderately elevated (eg <14mmol/L)—representing an atypical presentation for DKA, which could delay diagnosis and treatment. Therefore inform patients of the si Continue reading >>

The Management Of Diabetic Ketoacidosis In Adults

The Management Of Diabetic Ketoacidosis In Adults

Action 1: Commence 0.9% sodium chloride solution (use large bore cannula) via infusion pump. See Box 2 for rate of fluid replacement Action 2: Commence a fixed rate intravenous insulin infusion (IVII). (0.1unit/kg/hr based on estimate of weight) 50 units human soluble insulin (Actrapid® or Humulin S®) made up to 50ml with 0.9% sodium chloride solution. If patient normally takes long acting insulin analogue (Lantus®, Levemir®) continue at usual dose and time Action 3: Assess patient o Respiratory rate; temperature; blood pressure; pulse; oxygen saturation o Glasgow Coma Scale o Full clinical examination Action 4: Further investigations • Capillary and laboratory glucose • Venous BG • U & E • FBC • Blood cultures • ECG • CXR • MSU Action 5: Establish monitoring regimen • Hourly capillary blood glucose • Hourly capillary ketone measurement if available • Venous bicarbonate and potassium at 60 minutes, 2 hours and 2 hourly thereafter • 4 hourly plasma electrolytes • Continuous cardiac monitoring if required • Continuous pulse oximetry if required Action 6: Consider and precipitating causes and treat appropriately BOX 1: Immediate management: time 0 to 60 minutes (T=0 at time intravenous fluids are commenced) If intravenous access cannot be obtained request critical care support immediately Systolic BP (SBP) below 90mmHg Likely to be due to low circulating volume, but consider other causes such as heart failure, sepsis, etc. • Give 500ml of 0.9% sodium chloride solution over 10-15 minutes. If SBP remains below 90mmHg repeat whilst requesting senior input. Most patients require between 500 to 1000ml given rapidly. • Consider involving the ITU/critical care team. • Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

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