Endocrine emergencies pose unique challenges for the attending intensivist while managing critically ill patients. People with dka and hhs are best managed in an intensive care unit or stepdown setting 1,31,32 with specialist care 39,40. Guidelines for management of diabetic ketoacidosis the lancet. Background diabetic ketoacidosis dka is a costly, acute and life threatening complication of diabetes hospital admissions for dka are increasing. Diabetic and endocrine emergencies t kearney, c dang. Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the dkahhs itself. To address these issues the joint british diabetes societies jbds, supported by nhs diabetes, has produced this revision of the 2010 guidance developed by a multidisciplinary group of practicing specialists with considerable experience in this area. Diabetic ketoacidosis dka is a common endocrine emergency in veteri nary medicine. Diabetic ketoacidosis dka diagnosis, pathophysiology. For more information refer to chqgdl60016 diabetic ketoacidosis dka emergency management in children dka emergency management in children flowchart child with dka diagnosis bgl11 mmoll, ph management of diabetic ketoacidosis.
The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management. Guidelines and position statements from medical the care of their patients. Dka management and outcomes international journal of. Dka hhs ispad consensus guidelines pediatric diabetes. Guidelines for the management of patients with dka and hhs. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Interventions to improve dka management are effective in improving. We continually create new guidelines and update existing guidelines to reflect evolving clinical science and meet the needs of practicing physicians. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. British society of paediatric endocrinology and diabetes bsped guidelines for the management of. European society for paediatric endocrinologylawson.
Volume status including fluid intake and output, vital signs. Understand diabetic ketoacidosis dka with this free medical course. Lawson wilkins pediatric endocrine society lwpes, european society for pediatric endocrinology espe, and the international soci. Adult diabetic ketoacidosis dka guidelines and management record ward doctor surname umrn given names dob gender address postcode telephone these guidelines are for the treatment of adults with diabetic ketoacidosis dka and are designed to allow both prescriptions and relevant observations to be recorded together. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in. Endocrine emergencies postgraduate medical journal. Guidelines for management of diabetic ketoacidosis. Hyperglycemic emergencies diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are common presentations in the ed that require swift, specialized management strategies. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes.
The underlying stimulus of hhs must be discovered and treated. Thereis agreement that prevention of dka and reduction of. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. Protocols and insulin management software systems 41 may be beneficial 42,43, but there can be challenges with achieving adherence 44,45. Management of diabetic ketoacidosis in adults clinical guideline v4. There is debate as to whether physicians treating dka can prevent or predict the occurrence of cerebral edema and the appropriate sitesforchildrenwithdkatobemanaged. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped.
Endocrine disorders and therapeutic management flashcards. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Guidelines american association of clinical endocrinologists. Management of diabetic ketoacidosis in adults clinical. In the last decade, however, there has been a change in the way patients with dka present clinically and in addition there has been rapid development of nearpatient testing. Review of evidence for adult diabetic ketoacidosis. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Obtain endocrine consult on all patients on continuous tube feeds or new type 1 dm and others as needed. Specific guidelines exist for the management of dka in children.
Joint british diabetes societies inpatient care group. Diabetic and endocrine emergencies are traditionally treated by the acute medical admitting team or accident and emergency department staff. We are dedicated to providing the field of endocrinology with timely, evidencebased recommendations for clinical care and practice. This will include the diabetic diet carbs, fats, proteins, exercise regime how to. The goals of medical management are rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. Management of dka should be mainly directed to correction of acidosis. The nursing management approach to patients with dka is similar to that of. In patients aged 16 years presenting with dka, the management of dka should be discussed with relevant paediatric staff. Most will see diabetic emergencies on a regular basis, as they are common and both type 1 and type 2 disease are increasing in prevalence. Management of acute diabetic ketoacidosis dka below is the link to the care pathway for the management of diabetic ketoacidosis in adults. Management of diabetic ketoacidosis article pdf available in the indian journal of pediatrics 785. British society of paediatric endocrinology and diabetes bsped guidelines for. Individualize all glycemic targets a1c, fpg, ppg 5.
The therapeutic goals of dka management include optimization of 1. Diabetic ketoacidosis dka is an endocrine emergency occurring in new onset and established type 1 diabetic patients. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. Diabetic ketoacidosis dka, hyperglycaemic hyperosmolar state hhs and hypoglycaemia are serious complications of diabetes mellitus that. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with hhs.
Dka represents the initial manifestation of t1d in 80% of cases and it can also occur in 25% of cases of type 2 diabetes at onset. In addition, dka is a common complication in patients with known diabetes, where it may be the consequence of illness. Diabetic and endocrine emergencies denver, colorado. Management the treatment goals for dka and hhs are to correct the fluid depletion, decrease the blood glucose level, correct the electrolyte imbalance and treat the precipitating causes. Dka results in acute metabolic derangement in dogs and cats, requiring prompt medical treatment. Flow chart for diabetic ketoacidosis in adults management of.
Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counter. Journal of diabetes and endocrine practice free full. Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. Backgrounddiabetic ketoacidosis dka is an endocrine emergency with associated risk of morbidity and mortality. To determine the efficacy and safety of a diabetic ketoacidosis dkapower plan pp for guiding intravenous iv insulin infusions prior to anion gap ag closure and administering subcutaneous sc insulin.
Despite this, dka management lacks strong evidence due to the absence of large randomised controlled trials rcts. Diabetic ketoacidosis dka management algorithm adult. Fluid and electrolyte therapy in endocrine disorders. Diabetes mellitus pharmacology medications nclex nursing.
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