DKA Management Flashcards
what are the diagnostic criteria for DKA?
- serum glucose > 250 mg/dL
- arterial pH < 7.3
- serum HCO3- < 18
- at least moderate ketonuria or ketonemia
first step in treating DKA, after:
- complete initial evaluation
- check capillary glucose
- check serum/urine ketones
- confirm hyperglycemia
- check for ketonuria/ketonemia
start IVF: 1 L of 0.9% NS/hr
first step when determining which IVF to give
hydration status:
- severe hypovolemia
- mild hypovolemia
- cardiogenic shock
IVF if DKA pt has severe hypovolemia
0.9% NS 1 L/hr
next step if DKA pt has mild hypovolemia
evaluate CORRECTED serum Na+
next step if DKA pt has cardiogenic shock
hemodynamic monitoring/pressors
IVF if DKA pt has mild hypovolemia and HIGH serum Na+
0.45% NS, 250-500 mL/hr, depending on volume state
IVF if DKA pt has mild hypovolemia and NORMAL serum Na+
0.45% NS, 250-500 mL/hr, depending on volume state
IVF if DKA pt has mild hypovolemia and LOW serum Na+
0.9% NS, 250-500 mL/hr, depending on volume state
when do you change IVF to D5W/0.45%, and at what rate?
- serum glucose reaches 200 mg/dL
- 150-200 mL/hr
what are the 2 different options for insulin administration?
IV, or SC (if uncomplicated)
what is the dose of the insulin bolus?
0.1 U/kg
at what dose and rate is regular insulin given?
0.1 U/kg/hr IV continuous infusion
at what rate should regular insulin be given in continuous infusion if an initial bolus is not given?
0.14 U/kg/hr
what is the goal rate that serum glucose should fall?
50-70 mg/dL
next step if serum glucose does not fall by 50-70 mg/dL w/i FIRST hour
double insulin bolus
next step when serum glucose reaches 200 mg/dL
reduce regular insulin infusion to 0.02-0.05 U/kg/hr
between what levels should serum glucose be maintained, and until when?
- 150-200 mg/dL
- until RESOLUTION OF DKA
when is DKA considered to be resolved?
- normalization of serum AG (< 12 mEq/L) and blood beta-hydroxybutyrate levels
- when pts w/ hyperosmolar hyperglycemic state (HHS) are mentally alert and plasma Osm < 315 mOsmol/kg
- pt is able to eat
how often should labs (electrolytes, BUN, venous pH, creatinine) be checked?
2-4 hrs, until STABLE
next step after resolution of DKA/pt able to eat
- initiate SC multidose insulin regimen
- CONTINUE IV insulin infusion for 1-2 HOURS after SC insulin is given
in insulin NAIVE pts, what is the starting dose for SC insulin?
0.5 U/kg to 0.8 U/kg body weight per day (adjust as needed)
first step in assessing potassium in DKA
establish adequate renal function (UO about 50 mL/hr)
if serum K+ < 3.3 meq/L
- HOLD INSULIN
- give K+ 20-40 meq/hr until > 3.3 meq
if serum K+ > 5.3 meq/L
- do NOT give K+
- check K+ every 2 hrs
if serum K+ is 3.3-5.3 meq/L
give K+ 20-30 meq/LITER of IVF
keep K+ between 4-5 meq/L
assessing need for HCO3-:
pH 6.9 or MORE
NO HCO3-
assessing need for HCO3-:
pH LESS THAN 6.9
dilute NaHCO3 (100 mmol) in 400 mL H2O w/ 20 meq KCl; infuse over 2 hrs
NaHCO3 administration should be given how often, and until when?
Q2H until pH > 7.0
