Treatment of DKA

(BMJ 2019;365:1114)

參考➡️ Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

1. 目標：關門，想辦法把陰離子奸細關起來
2. 方法：給水、給insluin
3. 注意：補鉀、酸鹼

R/o possible precipitants

• Infection, intra-abdominal process, MI, etc. (see above)

Aggressive hydration

• 1L NS then ~250 cc/hr, tailor to dehydration & CV status

Insulin

• 0.1 U/kg bolus followed by 0.1 U/kg/h IV

Continue insulin drip until AG normal

• If glc <250 and AG still high → add dextrose to IVF and ↓ insulin drip to 0.02—0.05 U/kg/hr
• AG nl & can eat → SC insulin (overlap IV & SC 2–3 h)

Electrolyte repletion

• K: add 20–40 mEq/L IVF if serum K <5.4; insulin
• promotes K entry into cells → hold insulin if K <3.3. Careful K repletion in Pts with renal failure.
• HCO3: consider repletion if pH <6.9 or if cardiac instability

Explain by ChatGPT

Monitor

• Q1h GCS, Q1h vitals, Q2h ABG, Q2h electrolytes, Q2h glucose

• First, check for possible causes of DKA, such as infection, abdominal pain, or heart attack.
• Second, give the patient aggressive hydration by IV, starting with 1 liter of saline solution, then 250 cc per hour. Adjust according to dehydration and heart status.
• Third, give insulin IV, 0.1 units per kilogram of body weight, followed by 0.1 units per kilogram per hour.
• Fourth, continue the insulin drip until the anion gap is normal. If the blood sugar is less than 250 and the anion gap is still high, add dextrose to the IV fluid and decrease the insulin drip to 0.02-0.05 units per kilogram per hour.
• If the anion gap is normal and the patient can eat, give subcutaneous insulin (overlap IV and subcutaneous for 2-3 hours).
• Fifth, replace electrolytes. If potassium is less than 5.4, add 20-40 mEq/L IV. Insulin promotes potassium entry into cells, so hold the insulin if potassium is less than 3.3. Be careful when replenishing potassium in patients with renal failure.
• If the pH is less than 6.9 or if cardiac instability, consider replenishing bicarbonate.
• Sixth, monitor the patient every hour for consciousness, every hour for vital signs, every 2 hours for blood gas, every 2 hours for electrolytes, and every 4 hours for blood sugar.

窩的英文不太好

＃＃ 監視器

• Q1h GCS、Q1h 生命體徵、Q2h ABG、Q2h 電解質、Q2h 葡萄糖

• 首先，檢查 DKA 的可能原因，例如感染、腹痛或心髒病發作。
• 其次，通過靜脈注射給患者積極補液，從 1 升生理鹽水開始，然後每小時 250 毫升。根據脫水和心臟狀況進行調整。
• 第三，給予胰島素 IV，每公斤體重 0.1 單位，然後每小時每公斤 0.1 單位。
• 第四，繼續胰島素滴注直至陰離子間隙正常。如果血糖低於 250 而陰離子間隙仍然很高，則在靜脈輸液中加入葡萄糖並將胰島素滴注量減少至每小時每公斤 0.02-0.05 單位。如果陰離子間隙正常且患者可以進食，則給予皮下胰島素（重疊靜脈注射和皮下注射 2-3 小時）。
• 五、更換電解液。如果鉀低於 5.4，則增加 20-40 mEq/L IV。胰島素促進鉀進入細胞，因此如果鉀低於 3.3，則停止胰島素。腎功能衰竭患者補鉀時要小心。如果 pH 值低於 6.9 或心臟不穩定，考慮補充碳酸氫鹽。
• 第六，每小時監測一次患者的意識，每小時監測生命體徵，每 2 小時監測一次血氣，每 2 小時監測一次電解質，每 4 小時監測一次血糖。