Dka Management Guidelines

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The Evolution Of Dka Management | Dhatariya | British Journal Of Diabetes

Address for correspondence: Dr Ketan Dhatariya Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. The Joint British Diabetes Societies (JBDS) looked in detail at the evidence based management for diabetic ketoacidosis (DKA) and generated a set of guidelines to support the management of this complex condition. Because of the nature of research into DKA there are some areas which have less of an evidence base, so expert commentary and experience support several of the recommendations. This article describes the historical basis of the development of the management of this condition, how we came to arrive at the present situation and why the ongoing national DKA audit is so important in elucidating what is currently happening across the UK in clinical practice. Key words: diabetic ketoacidosis, guideline development, diabetic coma, insulin, evidence based medicine. In 2010 the JBDS produced a national guideline for the management of DKA.1 By 2013 data presented at the Diabetes UK Annual Professional Conference showed that over 85% of all UK hospitals who responded to an online questionnaire said that they had either adopted or ad Continue reading >>

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  1. M00glemuffins

    Since I first started keto a month and a half ago I've lost 20 pounds which has been absolutely fantastic. I don't feel like I'm eating rabbit food, I don't feel like I'm starving, and for the most part all the recipes I've tried have been delicious. Despite all of these postive outcomes, there is something that is driving me so crazy I am getting to a point where I just want to quit. The metallic taste in my mouth from all the ketones is becoming too much to bear. I feel like I'm sucking on a dirty old penny all day every day and no amount of teeth brushing, or mouthwash gargling gets it to stop. My mouth feels cottony, my breath smells bad, and I am just sick and tired of it. I've tried drinking water constantly to just try to wash it out but it never leaves!
    Does anyone have any tips or tricks to deal with the metal taste? Would adding more carbs so I'm not so deep in ketosis help? Any special drinks or toothpastes? I've gotten so much good out of this, and I don't want one stupid little thing to be what screws it up.

  2. A_isnt_A

    Mine went away (or at least improved) once I was better adapted. Less excess ketones to expel because your body uses them more efficiently.

  3. brianmcmanus

    Mine also got much better as I got more adapted, but it took 4 months or so. It is a nasty smell/taste for sure. I've been gargling with mouth wash after I brush my teeth in the morning and evening and that seems to help. Hang in there, the benefits outweigh the stank breath! Haha.

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DKA diabetic ketoacidosis nursing management pathophysiology & treatment. DKA is a complication of diabetes mellitus and mainly affects type 1 diabetics. DKA management includes controlling hyperglycemia, ketosis, and acdidosis. Signs & Symptoms include polyuria, polydipsia, hyperglycemia greater than 300 mg/dL, Kussmaul breathing, acetone breath, and ketones in the urine. Typically DKA treatment includes: intravenous fluids, insulin therapy (IV regular insulin), and electrolyte replacement. This video details what the nurse needs to know for the NCLEX exam about diabetic ketoacidosis. I also touch on DKA vs HHS (diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome (please see the other video for more details). Quiz on DKA: http://www.registerednursern.com/diab... Lecture Notes for this video: http://www.registerednursern.com/diab... Diabetes NCLEX Review Videos: https://www.youtube.com/playlist?list... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary

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 eligi Continue reading >>

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  1. Nick

    I'm on a ketogenic diet and have stopped taking protein shakes (excepting post-workout protein powder with water) because I've heard that it may cause an insulin spike. Is it true that protein powder with water will knock you out of ketosis? The one I'm using in particular is Optimum Nutrition Gold Standard 100% Whey.

  2. MattyP

    Yes it can.
    Protein is made up of seven different aminos, some of which (just as j.rightly correctly pointed out) can knock you out of ketosis because they are broken down into glucose in your blood.
    j.rightly is corrct. Do some research and it will confirm that protein can knock you out of keto. Anyone who says it can't doesn't understand the science behind it.
    That is why you are meant to eat about 65% of your diet from fats, 30% protein and no more than about 5% carbs (which will be incidental from your fat & protein based meals) to be sure you stay in ketosis.

  3. JoJo

    Ketosis is the deprivation of carbs. High end protein shakes, such as your ON Gold, don't contain many carbs. Thus, drinking your protein shake won't remove you from your ketogenic state. On the other hand, cheap proteins (Muscle Milk) and any protein labeled as "mass builder" will contain carbs to prevent ketosis.
    Your comment about protein shakes spiking insulin is wrong. Insulin is secreted to process sugar. Your ON Gold with water has hardly any sugar. Thus, drinking your protein shake will not spike your insulin. Insulin spikes usually only occur when you eat simple carbs from fruit, candy, etc...

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My Site - Chapter 15: Hyperglycemic Emergencies In Adults

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) should be suspected in ill patients with diabetes. If either DKA or HHS is diagnosed, precipitating factors must be sought and treated. DKA and HHS are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. A normal blood glucose does not rule out DKA in pregnancy. Ketoacidosis requires insulin administration (0.1 U/kg/h) for resolution; bicarbonate therapy should be considered only for extreme acidosis (pH7.0). Note to readers: Although the diagnosis and treatment of diabetic ketoacidosis (DKA) in adults and in children share general principles, there are significant differences in their application, largely related to the increased risk of life-threatening cerebral edema with DKA in children and adolescents. The specific issues related to treatment of DKA in children and adolescents are addressed in the Type 1 Diabetes in Children and Adolescents chapter, p. S153. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are diabetes emergencies with overlapping features. With insulin deficiency, hyperglycemia causes urinary Continue reading >>

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  1. chelseyRN

    This is my 13th day on the ketogenic diet. I bought ketone test strips to test my urine. I've been testing a few times a day and been in the low range. This morning I've tested twice and it says "Large" and correlates with the "8 mmol/L" color on the test strips. I've been "high fat, moderate whole foods carbs" for months, if not longer. I'm not diabetic but have a glucometer to test for blood sugar spikes to know what foods to avoid. My blood sugars have been 60-90s consistently. Is there any concern about spilling too many ketones? Educate me please!!

  2. Jason_v

    Just due to the nature of the presence of the 3 different versions of circulating ketones, some will always spill over to the urine. how detectable they are will depend on your hydration level more than anything else. So no there is no concern, which is good because you can't do anything about it anyway. If you are producing ketones, some will show up in the urine:period. if you are hyper hydrated you won't see many, if you are dehydrated you will see dark purple. Exercise tends to reduce the amount of ketones in the urine, in my experience. There is a falsehood that circulates that your body "learns" to use ketones more effectively thus "spilling less" into the urine but that's not technically correct. Although the use of ketones by different tissues can be up regulated (made more efficient depending on demand) there will always be some in the urine if you are producing them at all.

  3. ketohealthclub

    I'd love to read the data explaining that. Do you have any links? I've definitely read the opposite: that over time your body wastes fewer ketones, which renders the ketostix pretty useless after a few weeks.

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