Treatment for dka diabetes,s-61 fire king,mappy de - For Begninners

Diabetic ketoacidosis, also known as DKA, is a potentially life threatening condition in people suffering from diabetes mellitus. The first thing to do is to take a patient suffering from diabetic ketoacidosis to the hospital.
Since the acute condition occurs from fluid loss, the first step should be to replace this lost fluid as quickly as possible.
This restoration should follow a pattern, preferably by administering up to 3 liters of isotonic sodium or lactated Ringer solution in the first hour; another liter in the second hour and the another liter within the next two hours. When the patient stabilizes after the initial condition, the next step will be to start the insulin therapy.
Initially, low doses should be used so that the person does not suffer from conditions like hypokalemia (very low level of potassium in the body) or hypoglycemia (very low level of sugar in the body). Dehydration often results in loss of vital salts and electrolyte imbalance, mostly the loss of potassium.
This stage is only necessary when the patient is suffering from any accompanying infection. A relative insulin deficiency results in a decreased peripheral uptake of glucose and increased hepatic gluconeogenesis. Glucose is broken down into pyruvate by the glycolytic pathway and in the presence of sufficient oxygen is able to enter the Krebs cycle and electron transfer chain situated in the mitochondria.
Thiamine is a necessary cofactor of pyruvate dehydrogenase, which turns pyruvate into acetyl coenzyme A before it enters the Krebs cycle. It is a key element in bone structure and is involved in many extracellular and intracellular processes. The calcium ion also acts as a second messenger within signal transduction pathways in the nervous and endocrine system as well as in muscle contraction.
Tufts OCW material is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License. This condition occurs when the body starts to burn fat and produce acidic ketones as byproduct. In the process water gets removed from the blood stream resulting in conditions like dehydration, hypotension, etc. It is advised that the patient must be treated in the ICU for the first day or two depending on the seriousness of condition. Generally intravenous solutions are used to replace the lost intra-vascular and extra-vascular fluid as well as the lost electrolyte.


Then, till the patient recovers, one liter of the solution should be administered every four hours. However, precaution must be taken to see how much ready the patient is to take the treatment. It is very important to keep a check as there is often a chance of hypoglycemia setting in as the treatment of diabetic ketoacidosis with insulin progresses. So it is very important that this level must be brought back to normal as early as possible. To maintain glycolysis and limited ATP production, it is metabolised in the cytoplasm to lactate.
Unfortunately, as many as 20-30% of cases of diabetic ketoacidosis may be the initial presentation of previously undiagnosed diabetes. If the level of potassium falls drastically, then electrolyte replacement is done prior to insulin treatment as the condition can degenerate into serious cardiac arrhythmia. Though the risk group consists of people suffering from Type 1 diabetes, those who have Type 2 are not immune to this condition too. But this too needs to be regulated so that this does not contribute to worsening the condition of hypokalemia. Treatment with sodium bicarbonate is an extreme necessity and in most cases diabetic ketoacidosis improves with the above mentioned three steps.
As the patient becomes more ill, they will begin to vomit and may complain of abdominal pain.
When diabetic ketoacidosis occurs as the initial presentation in the newly diagnosed diabetic, the symptoms are often gradual in onset, with progressive dehydration and slowly developing ketosis. The onset of symptoms may be more rapid in children with established diabetes.Risk Factors for DKASexThere is no difference in DKA rates between the sexes at diagnosis and during early childhood. The use of insulin pumps and continuous subcutaneous insulin infusion hold great promise in decreasing this risk.Inadequate Insulin UseFailure to take insulin is the most common cause of recurrent DKA, particularly in adolescents. The patient may also run out of insulin, have a calibration error in the injection device, use the wrong concentration or type of insulin, or inadvertently inject an inadequate dose of insulin. A change of diet or exercise may also mean that the insulin administered is inadequate.Eating DisordersIn adolescents with type 1 diabetes, psychological problems complicated by eating disorders may be a contributing factor in as many as 20% of recurrent ketoacidosis cases. Typical signs include reduced skin elasticity (poor skin turgor), dry mucous membranes, hypotension, Kussmaul respiration, and tachycardia from the volume deficits. If the patient is carefully examined, the rapid, deep breathing typical of Kussmaul respirations is often found.


A fruity odor to the breath is often cited as due to the acetone and ketone bodies associated with DKA.46Lethargy is common, and some patients experiencing DKA will present in a coma. Mental status changes may occur in DKA ? these may be the result of DKA or may be due to an underlying process that caused the patient to develop DKA. If a mental status change is present, it is important to consider cerebral edema as the potential cause. The massive diuresis may contribute significantly to the electrolyte abnormalities seen in DKA. Free water, sodium, potassium, magnesium, and phosphate electrolytes are excreted into the urine along with the glucose. Ketoacids act as nonresorbable ions in the kidney and are excreted as potassium and sodium salts. Fluid losses may be smaller than when the patient has normal renal function, and fluid replacement must be much more conservative. Therapeutic emphasis will switch to insulin, careful monitoring of potassium, and consideration of dialysis.Urinalysis and Urine CultureA dipstick urinalysis is useful for identifying ketonuria. However, according to the American Diabetes Association guidelines, a serum measurement of beta-hydroxybutyrate is the preferred method of measuring ketones in children with suspected or confirmed DKA.5 The reason given in support of this recommendation is that the nitroprusside method for measuring ketones in the urine only measures acetoacetic acid and acetone, not beta-hydroxybutyrate, the dominant acid in DKA. Because beta-hydroxybutyrate is converted to acetoacetic acid during successful treatment of DKA, acetoacetic acid levels rise, which may lead to confusion as to whether the acidosis is improving or worsening.
It certainly seems reasonable to order a urine culture on children who would otherwise meet the indications for ordering a urine culture in children without DKA. It does not react with the nitroprusside, so urine or blood testing for ketones may be negative or only slightly positive. Sepsis, accumulation of lactate, and poor tissue perfusion prevent the formation of acetoacetate, which does react with nitroprusside. The resultant increase in acetoacetic acid may make the serum or urine testing for ketones more positive, despite clinical improvement and an increasing pH and decreasing anion gap.



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