Dka Management Guidelines

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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 information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... Popular Playlists: "NCLEX Study Strategies": https://www.youtube.com/playlist?list... "Fluid & Electrolytes Made So Easy": https://www.youtube.com/playlist?list... "Nursing Skills Videos": https://www.youtube.com/playlist?list... "Nursing School Study Tips": https://www.youtube.com/playlist?list... "Nursing School Tips & Questions": https://www.youtube.com/playlist?list... "Teaching Tutorials": https://www.youtube.com/playlist?list... "Types of Nursing Specialties": https://www.youtube.com/playlist?list... "Healthcare Salary Information": https://www.youtube.com/playlist?list... "New Nurse Tips": https://www.youtube.com/playlist?list... "Nursing Career Help": https://www.youtube.com/playlist?list... "EKG Teaching Tutorials": https://www.youtube.com/playlist?list... "Personality Types": https://www.youtube.com/playlist?list... "Dosage & Calculations for Nurses": https://www.youtube.com/playlist?list... "Diabetes Health Managment": https://www.youtube.com/playlist?list...

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. markh

    My wife just did a ketone test - she is doing a LCHF keto diet to help address adrenal/thyroid issues and we are in week six - all is wonderful and going well and we thought we would do a test using our meter. Her reading seems a little high, placing it outside the normal range for nutritional ketosis. What are likely factors in this and is there any cause for concern? She is generally eating OK but not a tremendous amount - eating what she feels she needs to and her weight is stable at around the right level.

    TIA, Mark

  2. thekgentleman

    Does she feel fine? I’m guessing since you said meter, you are testing via blood? Are you testing blood glucose as well? Was this after a fast? Do you have other readings? Is there a trend? 3+ is considered ‘deep’ ketosis. I do not think there is a reason for concern.

  3. EZB

    Don’t worry about the ketone level. I assume this is by blood test? As long as the reading is above 0.5 and she isn’t a type-1 diabetic, there is no issue, and she is in ketosis. The readings will be higher at the beginning stages of the diet. As time goes on, your body gets more adjusted to using the ketones, and the readings will be lower–even below 0.5 for some people, such as @richard .
    I have noticed that each time I fast, my ketones take longer to go up a ton also. I am 96 hours into a 120-hour fast now. My ketone levels yesterday (at hour 72) was 2.0. The first time I did a 72-hour fast, it was above 5.0 at hour 72. Today, at hour 96, it is 4.8! I bet that the next time I go 4 days, it will be 2.0 this far in.

    The body adapts. She feels fine, and she is fine.

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How to use Clinical Practice Guidelines in daily practice; with patients, students and stakeholders.

Diabetic Ketoacidosis: Clinical Practice Guidelines

1. Introduction Diabetic ketoacidosis (DKA), the most common endocrinal emergency remains a life-threatening condition despite improvements in diabetes care [1]. The mortality and morbidity rates remain high worldwide, especially in developing countries and among non-hospitalized patients [2,3], which highlight the importance of early diagnosis and implementation of effective preventive and management strategies. The adage "The child is not a miniature adult" is most appropriate when considering DKA. The fundamental pathophysiology of DKA is the same in children as in adults; however, the child differs from the adult in a number of characteristics which raise some important considerations in management [2]. The purpose of this chapter is to briefly review the pathophysiology of DKA and discuss recommended treatment protocols and current standards of care pertaining to children, adolescents and adults with type 1 or 2 diabetes presenting with DKA. The information provided is based on evidence from published studies and internationally accepted guidelines whenever possible and, when not, supported by expert opinion or consensus [1-5]. Current concepts of cerebral edema, recommendatio Continue reading >>

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  1. What_the_Anus

    Hi, I've been on the keto diet for about 67 days now;
    Cut to the chase: My cousin got gout and it scared me to do a blood test since i might have one to many chicken in my diet lol. Anyway here's the results.
    The nurse said it's wayyy to high for a young age (20) like me to have that kind of cholesterol and especially concerned with the LDL cholesterol level. My uric acid is also quite high which is sadly expected. She also said that it's weird my glucose level is low but i have trace amount of glucose in my urine. So what do i now? Should i continue on keto or just pick a normal low calorie diet? I was thinking of continuing keto till the end of the year and reach my goal body fat % but maybe it's not worth risking my health?
    My typical diet goes like this:
    2 Chicken thighs (cooked with ghee / vegetable oil)
    1 egg
    Brown butter sauce
    Occasional diet coke
    Dinner (soup):
    + 2 eggs
    + 1 smooth egg tofu (<10g carbs)
    + 1 Fish cake (<10g carbs)
    Occasional +Australian beef
    I'm in college so I tend to just cook with whatever I can buy cheapest and easiest lol.

  2. gogge

    On average keto lowers triglyceride levels by about 20 mg/dl. That you have a triglyceride level of 280+ mg/dl likely just means that you didn't fast long enough before the test and need to retake the test while fasting for 12+ hours. If you did fast for 12+ hours you either had worse numbers before starting keto, maybe NAFLD, or that you have some underlying issue, perhaps genetics like familiar hypertriglyceridemia or that you respond very badly to keto.
    Either way you need to do a second test while fasted, just drink water don't eat anything for 12 hours before the test. If your values are still this bad you can either try and wait it out, if it's NAFLD another test in a few months should show better numbers, or quit keto and see if things improve.
    US numbers:
    Total: 379 mg/dl
    HDL: 33 mg/dl
    LDL: 290 mg/dl
    Trigs: 283 mg/dl

  3. ketogenicendurance

    I would recommend reading Cholesterol Clarity. If you are doing Keto properly and strictly, cholesterol is rarely an issue.
    I presume the nurse had no idea what keto is or that you were doing it?
    Also what vegetable oil are you using?

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A lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Hyperglycemic Crises In Adult Patients With Diabetes

Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are the two most serious acute metabolic complications of diabetes. DKA is responsible for more than 500,000 hospital days per year (1,2) at an estimated annual direct medical expense and indirect cost of 2.4 billion USD (2,3). Table 1 outlines the diagnostic criteria for DKA and HHS. The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA. HHS is characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis. These metabolic derangements result from the combination of absolute or relative insulin deficiency and an increase in counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Most patients with DKA have autoimmune type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness such as trauma, surgery, or infections. This consensus statement will outline precipitating factors and recommendations for the diagnosis, treatment, and prevention of DKA and HHS in adult subjects. It is based on a previous tech Continue reading >>

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  1. K

    Acetone breath

    Any other mommies experiencing this? I called the peds office which of course tried to send me to the er telling me my son ingested nail polish remover. (I always leave acetone soaked cotton balls on my sons playmat, doesn't everybody?
    ) So I've been researching a bit on my own and maybe he's not getting enough fat and carbs from me? It seems like the smell might be from him burning his fat stores. I had him tested for diabetes and it was negative. I'm wondering if I've been eating too healthy. He gets purees twice a day and oatmeal once a day but I'm thinking of bumping up his carb intake. He also nurses 5-6 times a day. He's 6 1/2 months, 30 inches and about 20 pounds. The first time I noticed it was after his vaccines and his 6 month appointment but it's been on and off for abot two weeks. Thanks!

  2. allik527

    Your milk is nutritionally perfect, even if your diet isn't. Women who are malnourished have continued to BF healthy babies. Does anyone else notice this smell? What about your pedi?

  3. germaphobemomma

    Ketosis is the only thing I know of that causes people to smell like acetone. I would try upping his carbs and see if that helps. You don't want your little guy losing weight. If it keeps up, I would definitely take him in to be checked out. Good luck!

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