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Low Co2 In Dka

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Please Remember Also, Guidelines And Protocols Are No Substitute For Clinical Exam And Expert Opinion.

If your patient does not continue to improve over the first 3-4 hours of treatment, please re-assess and seek expert opinion from endocrine and/or critical care. Pediatric Diabetic Ketoacidosis Guidelines For new onset diabetes in a pediatric patient NOT in DKA (see criteria below) • These guidelines may not be appropriate • Consult endocrine and pediatric admit resident • Utilize EPIC’s Order set labelled Pedi Diabetes New Onset For any pediatric patient in DKA, whether new onset or not • Initiate the following guidelines • Consult PICU and endocrine • Utilize EPIC’s order set labelled Pedi Diabetes DKA • Use 2 bag IV fluid system as determined by the excel file DKA IV fluids and roadmap Pediatric DKA Guidelines •The goal is correction of metabolic acidosis, not euglycemia. • Hyperglycemic (glucose > 200 mg/dL) AND • Metabolic Acidosis (pH < 7.3, bicarb < 15 mEq/L) AND • Mild pH 7.2-7.3, bicarb 10-15 • Moderate pH 7.1-7.2, bicarb 5-10 • Severe pH <7.1, bicarb <5 • Ketosis – blood and/or urine Criteria for diagnosis of DKA. All 3 must be satisfied • The vast majority of ch Continue reading >>

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  1. TheCommuter

    You can post this question on this site's Nursing Student Assistance Forums and perhaps get an answer. One of our frequent users, Daytonite, loves to give detailed answers to these types of questions.
    http://allnurses.com/forums/f205/

  2. ICRN2008

    Here is the formula for anion gap:
    Agap = Na + K - Cl -CO2
    I would think that the doctor would be monitoring the glucose level (not the agap) to determine when to stop the insulin drip. Anyone else have an idea?

  3. P_RN

    One of our wonderful members Mark Hammerschmidt has a great FREE MICU site:
    http://www.icufaqs.org/
    Check section 4.2
    It's all acidosis/alkalosis

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Bicarbonate In Diabetic Ketoacidosis - A Systematic Review

Abstract This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA). PUBMED database was used to identify potentially relevant articles in the pediatric and adult DKA populations. DKA intervention studies on bicarbonate administration versus no bicarbonate in the emergent therapy, acid-base studies, studies on risk association with cerebral edema, and related case reports, were selected for review. Two reviewers independently conducted data extraction and assessed the citation relevance for inclusion. From 508 potentially relevant articles, 44 were included in the systematic review, including three adult randomized controlled trials (RCT) on bicarbonate administration versus no bicarbonate in DKA. We observed a marked heterogeneity in pH threshold, concentration, amount, and timing for bicarbonate administration in various studies. Two RCTs demonstrated transient improvement in metabolic acidosis with bicarbonate treatment within the initial 2 hours. There was no evidence of improved glycemic control or clinical efficacy. There was retrospective evidence of increased risk for cer Continue reading >>

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  1. Knicks

    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment.

  2. generic

    The HCO3 derangement is not a compensation--it is the primary problem.
    DKA patients have a metabolic acidosis, I think it's mostly caused by the formation of tons and tons of ketone bodies (acidic). These are formed because despite high circulating levels of glucose, the cells can't use the glucose without insulin-->turn to ketone formation instead.
    The metabolic acidosis may cause respiratory compensation, which would give Kussmaul breathing, for example.

  3. treva

    Knicks said: ↑
    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment. Remember the kidney takes days to compensate for acidodic state by producing more bicarb. Acutely, the bicarb is used to buffer the extra acid, so it drops.
    This also explains why DKA pts have increased RR:
    CO2 + H20 <--> H2CO3 <--> HCO3- + H+
    If you blow off extra CO2 (ie by upping RR) you shift the above equation to the left, and promote the formation of H2CO3 via CA, helping to mop up the H+.

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What Are The Causes Of Low Carbon Dioxide In The Blood?

Carbon dioxide helps the blood vessels constrict and relax, and it also plays a role in cellular respiration. When a human inhales, he takes in oxygen. When he exhales, he releases carbon dioxide. Most of the carbon dioxide in the blood occurs in the form of bicarbonate. The carbon dioxide blood test, also called the bicarbonate test, measures the amount of bicarbonate in the bloodstream. Some medical conditions and drugs cause low bicarbonate levels. Kidney Disease The kidneys maintain normal levels of sodium, potassium, carbon dioxide and phosphorus in the blood. When kidney disease or kidney failure impairs kidney function, these organs no longer carry out this function properly. Carbon dioxide levels decrease, resulting in the need for treatment. The American Academy of Family Physicians reports that oral or intravenous sodium bicarbonate helps correct low levels of carbon dioxide in the blood. If carbon dioxide levels do not respond to this treatment, doctors prescribe dialaysis. During dialysis, a machine removes blood from the body, filters waste and returns the blood to the circulatory system via plastic tubes. Diabetic Ketoacidosis Diabetic ketoacidosis occurs when a perso Continue reading >>

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Popular Questions

  1. Knicks

    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment.

  2. generic

    The HCO3 derangement is not a compensation--it is the primary problem.
    DKA patients have a metabolic acidosis, I think it's mostly caused by the formation of tons and tons of ketone bodies (acidic). These are formed because despite high circulating levels of glucose, the cells can't use the glucose without insulin-->turn to ketone formation instead.
    The metabolic acidosis may cause respiratory compensation, which would give Kussmaul breathing, for example.

  3. treva

    Knicks said: ↑
    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment. Remember the kidney takes days to compensate for acidodic state by producing more bicarb. Acutely, the bicarb is used to buffer the extra acid, so it drops.
    This also explains why DKA pts have increased RR:
    CO2 + H20 <--> H2CO3 <--> HCO3- + H+
    If you blow off extra CO2 (ie by upping RR) you shift the above equation to the left, and promote the formation of H2CO3 via CA, helping to mop up the H+.

  4. -> Continue reading
read more close

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