How is DKA treated in ICU?
TREATMENT OPTIONS IN THE ED OR ICU The treatment of acute DKA includes restoration of fluid deficits in the first 24 to 36 h, electrolyte replacement and insulin therapy, which is administered slowly to decreased plasma glucose[23,24].
What is the medical treatment of DKA in hospitalized patients?
If you’re diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You’ll receive fluids — either by mouth or through a vein — until you’re rehydrated.
Do DKA patients go to the ICU?
Patients with diabetic ketoacidosis (DKA) commonly are admitted to the intensive care unit (ICU). Current emphasis on cost containment, coupled with decreased bed capacity, makes it critical to identify patients who could be managed safely in alternative settings.
When do you admit DKA to ICU?
We considered patients met criteria for ICU admission for Grades III and IV: pH < 7.2, bicarbonate <10, DBP <60, serum osmolality >or=to 330 or presence of a special situation. Methods: A retrospective review of all DKA ICU admissions from 9/96 to 6/97 was conducted.
How do you handle a patient with DKA?
Key DKA management points
- Start intravenous fluids before insulin therapy.
- Potassium level should be >3.3 mEq/L before the initiation of insulin therapy (supplement potassium intravenously if needed).
- Administer priming insulin bolus at 0.1 U/kg and initiate continuous insulin infusion at 0.1 U/kg/h.
Why NS is used in DKA?
Importance Saline (0.9% sodium chloride), the fluid most commonly used to treat diabetic ketoacidosis (DKA), can cause hyperchloremic metabolic acidosis. Balanced crystalloids, an alternative class of fluids for volume expansion, do not cause acidosis and, therefore, may lead to faster resolution of DKA than saline.
Why do we give dextrose in DKA?
Why is IV dextrose given to patients with DKA? When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr.
How long do you stay in DKA for ICU?
Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of fluid loss with intravenous fluids. Correction of hyperglycemia with insulin.
When is DKA resolved?
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
Why is DKA an emergency?
Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones.
What IV fluids do you give for DKA?
Fluid replacement. Glucose osmotic diuresis causes dehydration therefore in your management you should give between 4-6 liters,then reassess (caution in CHF).
What type of insulin is given for DKA?
Only short-acting insulin is used for correction of hyperglycemia. Subcutaneous absorption of insulin is reduced in DKA because of dehydration; therefore, using intravenous routes is preferable. SC use of the fast-acting insulin analog (lispro) has been tried in pediatric DKA (0.15 U/kg q2h).
What is mild DKA?
Moderate DKA is defined by a pH of 7.15-7.25 and can usually be treated on the ward. A pH >7.25 is mild DKA and usually can be treated in the ED over a 4-6 hour time. period, or on the floor, if admission is otherwise required.