Dka Management Flowchart

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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.....

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 a Continue reading >>

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  1. MrPandaChao

    Keto acids are organic compounds that contain both a carboxylic acid group and an ketone group (oxo group).
    Ketone bodies is the collective name of the three organic compounds (acetoacetic acid, β-hydroxybutyric acid and acetone) produced from metabolizing fatty acids during fastening, low carbohydrate intake or untreated insulin-dependent diabetes.
    Of these three ketone bodies, only acetoacetic acid is also a keto acid.

  2. Aristo_socrates

    Thanks! That really clears things up. Following this, is it only keto acids (acetoacetic acid and not the others) that are capable of causing ketoacidosis (clinical perspective)?
    Also, as certain amino acids can be converted into ketone bodies, can they also cause ketoacidosis? Assuming ketone bodies and keto acids are capable of causing acidosis.
    EDIT: Just read further into this and both beta-hydroxybutyric acid and acetoacetic acid are capable of causing ketoacidosis. Acetoacetate is unstable and often spontaneously forms acetone, which is volatile and poorly metabolised (giving the characteristic fruity smell in patients with diabetic ketoacidosis). This often presents as respiratory compensation (e.g. hyperventilation) and vomiting can also occur. Just to those also wondering!

  3. MrPandaChao

    You are right that acetone manifests as the fruity breath. The respiratory compensation is due to the lowered pH in the blood stimulating hyperventilation in order to increase pH in the blood by lowering CO2 in the blood (which also acts as an acid in the form of carbonic acid).
    So in essence trying to alleviate the lowered pH due to accumulation of non-volatile acids by reducing the amount of volatile acids in the blood (CO2).

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Flow Chart For Diabetic Ketoacidosis In Adults Management Of

Overview National guidelines flowchart for the management of DKA from the Joint British Diabetes Societies Inpatient Care Group. Clinical Guidelines This guideline has been approved by the Trust's Clinical Guidelines Assessment Panel as an aid to the diagnosis and management of relevant patients and clinical circumstances. Not every patient or situation fits neatly into a standard guideline scenario and the guideline must be interpreted and applied in practice in the light of prevailing clinical circumstances, the diagnostic and treatment options available and the professional judgement, knowledge and expertise of relevant clinicians. It is advised that the rationale for any departure from relevant guidance should be documented in the patient's case notes. The Trust's guidelines are made publicly available as part of the collective endeavour to continuously improve the quality of healthcare through sharing medical experience and knowledge. The Trust accepts no responsibility for any misunderstanding or misapplication of this document. Continue reading >>

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  1. Alice In TX/MO

    It's my fault. I admit that. Orange is eleven years old, and she struggled a bit with her pregnancy last year. However, she recovered nicely, and she was healthy, in heat, and flirting with the bucks, and I caved in to her insistence and let her get frisky last fall. Darn it. And, what with the varieties of chaos going on at the time, I don't have an exact breeding date.
    Now, she has ketosis. Her udder and vulva are swollen with edema, and she obviously does not feel well. She has lost weight.
    I found ketosis test strips at Wal Mart and tested her yesterday to confirm the suspicions I'd had for a week or so. OFF THE CHARTS ketosis.:run:
    For the last few days, she had been taking CMPK supplements via a drench gun, and, fortunately, she thinks it is yummy. On Yarrow's advice, I started Orange on a high carbohydrate diet. She's getting Fritos, crackers, oak leaves, and (this evening) a molasses sandwich. She is also getting "Magic" which is molasses, corn syrup, and corn oil. This gives her instant usable energy, so that she doesn't continue to digest her own fat and muscle to support life and kids. I'm giving her a SMALL amount of the grain mix that the other goats get.
    She had become less and less active over the last couple of weeks. After starting treating for ketosis, she is improving. This evening, when I went to the milk house/goat yard, she was on her feet in a browse area that I have for them.
    After a good phone consult with Yarrow, I'm thinking that these old does just have trouble with their metabolisms. Hopefully, I can get her through the last few days of this pregnancy and get one last set of kids. She will be the herd queen (UNBRED) for as long as she wants to stay with us after that.
    THANK YOU, YARROW, for taking the time this afternoon to advise me. :clap:

  2. yarrow

    I have all my fingers & toes crossed that you can keep her stable until the kids are well baked.. (I just came in a hour or so ago from kidding out Eve.. whose mother was also an old lady... who I fought and fought to keep her going until time to induce her.. Eve was the sole survivor of a set of triplets.. Eve just had really nice twin DOESLINGS..-both are black & white with full white belts.. one has a few BIG moon spots.).. super easy birth.. I see their grand dam in them both!!!... I think you should get to see Orange live on via her kids & grandkids.. one more time.. so.. like we talked about.. one day at a time.. keep her eating and drinking and I think you may well be able to get her to the finish line with live kids!..
    call anytime you need to/want to talk.. brainstorming with someone else always works better for me, when it's a tricky case

  3. GoldenWood Farm

    I will be praying for her Alice! I was worried because I knew you had called Susie (I was on the phone with her as well) and I hadn't seen a posting about it.
    Susie SO glad Eve kidded with does :nanner::nanner:. Send some vibes over to poor Penny!

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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - 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... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DI Continue reading >>

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  1. llabonte

    I was wondering if someone could answer a question for me. I am on week six or seven of Atkins (and loving it) and this is the second period I have had while on Atkins and once again I noticed I have dropped way down on the test strip. Yesterday, the first day of my period the test strip said I was in Large ketosis. This morning it is down to a "trace". I noticed the same thing last month. Is this normal or has anyone else noticed anything different during menstruation? (Sorry guys, don't mean to gross you out....!) I did have browned hamburger with diced tomatoes with chili powder (my version of chili on Atkins) and I had some sour cream and a mozerella stick also. Could that have anything to do with it? I wouldn't think so because the tomatoes were 5 carbs per 1/2 cup and I don't think I had anymore than the 1/2 cup and the chili powder had no sugar added. I know a womans body does strange things but I was just curious. I don't swear by the test strips but I like to watch myself.

  2. beginagain

    I believe your period can through off those ketosis test strips and that it's best to wait till after you period is done to test again. I had read this not too long ago on this healthboard I post on.

  3. amazin77

    I've been on atkins for quite awhile and love it so much. I defend it all the time. I tell people it's not all about fat. I chose my quality cuts of meat and fish with a nice salad etc. I make my own chicken strips dipped in mayonaise and roll in my ground almonds or flour when my sister brings to me.
    But to get to your TOM: I've found that it's true us woman's body chemicals change constantly during the day. I love like you using the ketostix frequently during the day, at least twice because I know my body well. During my period I've found it to be lighter in the morning when I've had no food yet, but when I get going and had some breakfast I check again before lunch. And I right there Large amount of Keto. I just put that big smile on in the bathroom and feel it mostly in my clothing. Some people don't like using it because when its lightly colored it does a trick to your mind. But understanding my body during the day I know I've been eating right guaranteed. When I check myself more than twice a day, is when I eat out at a fancy restaurant and a waiter tells me this is a good choice for atkins. Believe me, don't always believe the waiter, because immediatly I knew he was wrong with my plate choice, it had SUGAR. He appoligized, but there was nothing on the menu for me to eat, so I just enjoyed my hot tea....It really will be easier the longer your on it to understand what I'm saying about knowing this way of life and your own body. Ketositx aren't cheap, but you know I got myself fat and I really feel I deserve the extra to make me feel good and see the results on the test strip..... I'm sure you know what I mean. I hope I made you feel good.

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