Term
| DKA (Diabetic KetoAcidosis) |
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Definition
serious acute complication of DM, can be fatal if untreated;
may be reason for initial evaluation of newly diagnosed pt w/ Type 1 DM; |
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Term
| HHS (Hyperosmolar Hyperglycemic State) |
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Definition
serious acute complication of DM, can be fatal if untreated;
more common in Type 2 DM; |
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Term
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Definition
insulin deficiency (new onset or noncompliance, subtherapeutic insulin doses);
excess counter-regulatory hormones (infection, CVA, MI, EtOH abuse, pancreatitis, trauma, drugs [corticosteroids, thiazides, sympathomimetics]) |
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Term
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Definition
| polyuria, polydipsia, polyphagia, weight loss, vomiting, dehydration, weakness, mental status changes, poor skin turgor, tachycardia, hypotension, SHOCK, ABDOMINAL PAIN, KUSSMAUL RESPIRATION, EMESIS, FRUITY ODOR |
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Term
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Definition
| polyuria, polydipsia, polyphagia, weight loss, vomiting, dehydration, weakness, mental status changes, poor skin turgor, tachycardia, hypotension, COMA |
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Term
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Definition
BG: >250 mg/dl
Arterial pH: 7.00-7.30
HCO3: <10 - 18;
(+) urine ketones, serum ketones;
Serum Osmololality: varies;
Anion Gap: >=10;
Mental Status: alert--coma |
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Term
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Definition
BG: >600 mg/dl
Arterial pH: >7.30
HCO3: >18;
(+) small urine ketones, serum ketones;
Serum Osm: >320 mOsm/kg;
Variable Anion Gap;
Mental Status: stupor/coma |
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Term
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Definition
Na - (Cl + HCO3)
measures acid/base status |
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Term
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Definition
2(Na) + glucose/18 + BUN/2.8
measure of dehydration |
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Term
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Definition
correct: dehydration, electrolyte abnormalities, acidosis, hyperglycemia, precipitating events;
prevent complications;
education/follow-up; |
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Term
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Definition
Fluids;
Electrolytes: Potassium, Bicarb, Phos, Sodium;
Insulin |
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Term
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Definition
Tx of DKA;
Goal: expand intra- & extra-vascular volume, restore renal perfusion, resotre fluid deficits within 24 hrs;
Calculate corrected sodium level;
1st Hr: NS infused at rate of 15-20 mL/kg;
Subsequent Hrs - fluid choice depends on hydration status, electrolyte levels, urinary output:
- Normal Na or HypERnatremic: 1/2NS infused at 250-500 mL/hr;
- HypOnatremic: NS 250-500 mL/hr;
- Caution in compromised cardiac & renal fcn;
When glucose reaches 200 mg/dL, switch to D5W w/ 1/2NS infused at 150-250 mL/hr to keep glucose between 150-200 mg/dL (prevents hypoglycemia, cerebral edema);
Monitor: BP, renal fcn (ins/outs), electrolytes;
Takes 24 hrs to replace deficits |
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Term
| Potassium Recommendations for Tx of DKA/HHS |
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Definition
Administer once serum levels <5 mEq/L;
- 20-30 mEq per L of fluid
Keep level between 4-5 mEq/L |
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Term
| HCO3 Recommendations for Tx of DKA/HHS |
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Definition
DO NOT USE if pH >7.0;
If pH <6.9:
- 100 mmol NaHCO3 in 400 mL sterile water + 20 mEq/KCl, infused at 200 mL/hr;
repeat q2 hr until pH >7.0 |
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Term
| Phosphate Recommendations for Tx of DKA/HHS |
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Definition
Levels can decrease with insulin therapy;
ONLY indicated if levels <1 mg/dL;
Add 20-30 mEq/L KPhos to fluids |
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Term
| Insulin Recommendations for Tx of DKA/HHS |
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Definition
EXCLUDE HYPOKALEMIA before starting! K >=3.3 mEq/L;
Give initial IV bolus of 0.1 units/kg regular followed by 0.1 unit/kg/hr continuous infusion;
OR
Give IV infusion of 0.14 units/kg/hr
- Expect glucose level to decrease by 50-75 mg/dL in 1st hr, if it doesnt:
- recheck hydration status;
If hydration status is OK, pick 1 or 2:
1) give 0.14 units/kg IV bolus then continue as above,
OR
2) increase infusion rate every hour until decrease of 50-75 mg/dL is achieved;
Once BG reaches 200-300 mg/dL:
- decrease infusion rate to 0.02-0.05 unit/kg/hr OR give SC injection of rapid-acting insulin 0.1 units/kg q2 hr
***DO NOT DECREASE BG >75 mg/dl/hr!!!--> rapid decrease causes CEREBRAL EDEMA***
Maintain glucose between 150-200 mg/dL or 250-300 mg/dL;
When switching to SC insulin, administer 1st SC dose 1-2 hrs BEFORE D/Cing IV infusion |
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Term
| Monitoring Therapy of DKA/HHS |
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Definition
q1-4 hrs: electrolytes, glucose, BUN, Cr, osmolality, venous pH, calculate anion gap;
Resolution of DKA: glucose <=200 mg/dL + 2 of following:
- bicarb >= 15 mmol/L, venous pH >7.3, anion gap <= 12; |
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Term
| Counseling Points about DKA/HHS |
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Definition
Prevention is KEY!!!
Sick day management w/ insulin;
Recognize S/Sx of Hyperglycemia;
Test blood glucose levels; |
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