Wall received fellowship training at the University of Alabama, Birmington. Address correspondence to Abbas E. Kitabchi, Ph. Reprints are not available from the authors.
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In: National Diabetes Data Group. Diabetes in America. Bethesda, Md. Perform a venous blood gas for pH, bicarbonate, and potassium at 60 minutes, 2 hours, and 2 hourly thereafter. Aim for a reduction in blood ketones of 0. Use venous bicarbonate or blood glucose measurement if blood ketone measurement is not available. Aim for an increase in venous bicarbonate of 3.
If the target rates for blood ketones, blood glucose, and venous bicarbonate are not achieved: [2] Joint British Diabetes Societies for Inpatient Care. Check the insulin infusion pump is working and connected and that the correct insulin residual volume is present to check for pump malfunction. Increase the insulin infusion according to local protocols if there is no insulin pump malfunction until the target rates for ketones, glucose, and bicarbonate are achieved.
Maintain an accurate fluid balance chart. Recurrent diabetic ketoacidosis. Diab Med ; 5 : — The epidemiology of diabetic acidosis: a population-based study. Am J Epidemiol ; : —8. Hyperglycemic crises in urban blacks. Arch Intern Med ; : — Diagnostic delays of adult patients admitted to hospital with diabetic ketoacidosis. Diabet Med ; 21 : —1. Management of hyperglycemic crises in patients with diabetes. Diabetes Care ; 24 : — Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycemic crises.
J Crit Care ; 17 : 63 —7. Kreisberg R. Diabetic ketoacidosis: new concepts and trends in pathogenesis and treatment. Ann Intern Med ; 88 : — Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol ; 95 : —8. The influence of ketoacids on plasma creatinine assays in diabetic ketoacidosis. J Intern Med ; : — Alberti KG. Low-dose insulin in the treatment of diabetic ketoacidosis.
Treatment of diabetic coma with continuous low-dose infusion of insulin. Br Med J ; 2 : — Comparison of high-dose and low-dose insulin by continuous intravenous infusion in the treatment of diabetic ketoacidosis in children. Diabetes Care ; 3 : 15 — Lancet ; 2 : — Blood intermediary metabolite and insulin concentrations after an overnight fast: reference ranges for adults, and interrelations.
Clinical Chemistry ; 24 : — Clinical utility of b-hydroxybutyrate determined by reflectance meter in the management of diabetic ketoacidosis Letter. Diabetes Care ; 18 : —8. Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes ; 37 : —7. Acetone in diabetic ketoacidosis. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.
Diabetes Care ; 22 : 7 —9. Diabetic ketoacidosis charges relative to medical charges of adult patients with type I diabetes. Diabetes Care ; 20 : — Economic impact of diabetic ketoacidosis in a multiethnic indigent population: analysis of costs based on the precipitating cause.
Diabetes Care ; 26 : —9. Cost effectiveness of the direct measurement of 3-beta-hydroxybutyrate in the management of diabetic ketoacidosis in children. Diabetes Care ; 26 : The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.
Diabetes Nutr Metab ; 16 : — Bedside ketone determination in diabetic children with hyperglycemia and ketosis in the acute care setting. Pediatr Diabetes ; 5 : 39 — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. This should be followed by a reassessment Acidosis results in poor peripheral perfusion so use central capillary refill with vital signs to assess response to fluids Initial Fluid Replacement Commence rehydration with isotonic fluid eg 0.
Children can be given ice to suck on for comfort. The sodium chloride content should be at least 0. Phosphate If phosphate levels are dropping, the potassium added to IV fluids can be changed from potassium chloride to potassium phosphate. Calcium levels will require ongoing monitoring if this change is made. Initial insulin infusion rates Children with DKA should generally be commenced at 0. Discuss with consultant on call and liaise with intensive care or paediatric retrieval service to discuss transfer.
Overall, infective precipitants are uncommon. Children and adolescents with DKA should be managed in a unit that has: Access to laboratory services for frequent and timely evaluation of biochemical variables Experienced nursing staff trained in monitoring and management of DKA in children and adolescents A paediatrician, endocrinologist, or critical care specialist with training and expertise in the management of paediatric DKA.
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