DKA vs HHS¶
DKA vs HHS¶
Symptoms of DKA vs HHS¶
DKA¶
- ⪢250mg/dl of Blood glucose
DXD of DKA¶
Causes of DKA¶
DKA mng summary fro mTInitn¶
Fluid Resuscitation¶
| Time | NS Dose | Duration |
|---|---|---|
| Initial | 1,000 mL | 30 minutes |
| 500 mL | 30 minutes | |
| 500 mL | 60 minutes | |
| 500 mL | Every 2 hours |
Guidelines for Fluid¶
- Tailor the above rates with the patient’s cardiopulmonary status.
- Reassess every 2 hours and look for fluid overload.
- Restrict fluids in those with congestive cardiac failure or pulmonary edema.
Insulin Administration¶
On admission after IVF infusion
- IV infusion Insulin 0.1-0.14 unit/kg/h ,
Hypokalemia in ABG
hypokalemia exists (K+ <3.5 mEq/L), do not start insulin bolus or give the bolus dose until IV KCl supplementation is initiated urgently.
Potassium Correction
- CBG decreases by 50-75 mg/dL/h (2.8 to 4.2 mmol/L/h), after insulin infusion
-
CBG fails to drop 10% 1 hour after initial therapy, or 3 mmol/L/h, (assuming adequate hydration) ⇒ iv bolus insulin or Increase Infusion rate by 1ml
-
Failure to insulin response is 1-2% mostly due to infection
-
if CBG is 250 mg/dL (11 mmol/L), add dextrose to the IV fluids and reduce the insulin drip rate to 0.02 to 0.05 unit/kg/h till The Acidosis is managed
Acidosis Correction¶
- Give bicarbonate if the initial pH is <6.9
- 100 mEq (100 mmol) of sodium bicarbonate in 400 mL of water with 20 mEq (20 mmol) KCl at 200 mL/h for 2 hours until the venous pH >7.0.
why no Bicard need for acidosis
DKA acidosis usually clears with insulin infusion ,and oxidation of bicards by kidney and brain
Acidosis Complication
- CVS impared contractility ,vasodialtion ,hypotension
- CNS = Cerebro vascualr diatation and coma
indication of Sucessful Acidosis Mng¶
after CBG maintaince in >200mg/dl either - serum bicarbonate level >15 mEq/L, - venous pH >7.3, and/or a normal calculated anion gap -
Pitfalls in DKA Mng¶
Mortality casues¶
- Serum OSmolarity
- elevated BUN
- serum bicarbonate level (<10mEq/L)
Cause of Death in DKA
MI and Infection