Diabetic ketoacidosis - Revision history

Aidan: Text replacement - "<=" to "≤"

2022-09-30T15:31:43Z

Text replacement - "<=" to "≤"

← Older revision		Revision as of 15:31, 30 September 2022
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	** K 4-5.5: add 20 mmol KCL/L		** K 4-5.5: add 20 mmol KCL/L
	** K 3-4: add 40 mmol KCl/L		** K 3-4: add 40 mmol KCl/L
	** K ~~<=3~~: give 10-20 mmol KCl hourly until serum K over 3, then add 40 KCl mmol/L		** K ≤3: give 10-20 mmol KCl hourly until serum K over 3, then add 40 KCl mmol/L
	* Insulin		* Insulin
	** Insulin aspart hourly		** Insulin aspart hourly

Aidan: /* Memphis SC Insulin Protocol */

2022-02-28T00:28:12Z

Memphis SC Insulin Protocol

← Older revision		Revision as of 00:28, 28 February 2022
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	** Overlap with insulin running at half current rae for 6-8 hours after basal insulin		** Overlap with insulin running at half current rae for 6-8 hours after basal insulin

	=== Memphis SC Insulin Protocol ===		=== Memphis Insulin Protocol ===

	* IV fluids:		* IV fluids:

Aidan: /* Management */

2022-02-28T00:24:45Z

Management

@@ Line 59: / Line 59: @@
 ** Calculate total daily dose from IV rate x 24h, then give that dose as detemir/glargine twice daily (new TDD is twice the IV TDD)
 ** Overlap with insulin running at half current rae for 6-8 hours after basal insulin
 [[Category:Endocrinology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-18T12:07:48Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:07, 18 July 2020
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	* Preexisting diagnosis of T1DM		* Preexisting diagnosis of T1DM

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* History		* History

Maintenance script: Imported from text file

2020-07-04T01:17:31Z

Imported from text file

New page

== Definition ==

* An anion gap acidosis caused by an accumulation of ketone bodies secondary to severe insulin deficiency

== Etiology ==

* Missed insulin (most common cause)

== Pathophysiology ==

* Severe insulin deficiency causes the body to be unable to process glucose for energy, so instead relies on increased fatty acid metabolism, resulting in an accumulation of ketone bodies
* Hyperglycemia creates an osmotic diuresis which causes dehydration
* Insulin deficiency also causes a potassium shift from intra- to extracellular space, combined with the diuresis causes total body potassium depletion

== Differential Diagnosis ==

* DKA
* Hyperglycemia
* Hyperosmolar hyperglycemic state (HHS/HONK)

== Epidemiology ==

== Risk Factors ==

* Preexisting diagnosis of T1DM

== Clinical Presentation ==

* History
** Thirst/polyuria
** Nausea/vomiting/abdominal pain
** Weakness/malaise
** Change in mental status
* Exam
** Altered mental status
** Kussmaul respiration
** Fever
** Acetone on breath

== Investigations ==

* Glucose q1h
* SMA7 and VBG q2-4h

== Management ==

* Fluid resuscitation (most important)
** Aggressive fluid resuscitation is the best treatment for hyperglycemia
** Usually require 6-10L in first 24 hours
* Insulin therapy treats the ketoacidosis, so don't stop until anion gap resolves
** 0.1-0.2 units/kg/h (6-10 U/kg/h on average)
** Titrate based on anion gap and hyperglycemia
* Potassium supplementation: patients lose about 5mEq/kg when in DKA
** If initial K <3.3, must replace potassium before starting insulin
** Supplement to keep K between 4-5
* Sodium bicarb: consider adding when pH<6.8 or in respiratory failure
* Treat the underlying cause
* Change to subcutaneous insulin when glucose < 15, anion gap resolved (x12+ hours), and patient willing to eat
** Calculate total daily dose from IV rate x 24h, then give that dose as detemir/glargine twice daily (new TDD is twice the IV TDD)
** Overlap with insulin running at half current rae for 6-8 hours after basal insulin

[[Category:Endocrinology]]
[[Category:Critical care]]