Diagnosis and management of diabetic ketoacidosis in adults. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs remain two of the most commonly encountered metabolic emergencies. Immediate management acute management of diabetic ketoacidosis in adults this protocol is for the acute management of diabetic ketoacidosis in patients 16 years and over. It is commonly precipitated by poor adherence to medication, stress and concurrent illness. Dka is a series of events that starts with not having enough insulin for the present condition and leads to a serious imbalance in the blood. Georgia noblebell and alison cox are diabetes specialist nurses at kings college hospital, london. Diabetic ketoacidosis and hyperosmolar crisis in adults. Commence a fixed rate intravenous insulin infusion ivii.
Hhs formerly known as hyperosmolar nonketotic state. On 30 october 2015, we replaced the original flow diagram thank you for your interest in spreading the word about the bmj. The management of diabetic ketoacidosis in adults our. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Review emergency management of diabetic ketoacidosis in adults r d hardern, n d quinn emerg med j2003. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3. Guidelines for the management of hhs in adults are lacking, in contrast to dka, but hhs requires a different therapeutic approach to dka. Diabetic ketoacidosis and hyperosmolar hyperglycemic.
Guidelines for management of diabetic ketoacidosis. Review emergency management of diabetic ketoacidosis in. Noblebell g, cox a 2014 management of diabetic ketoacidosis in adults. Dka can occur in both type 1 and type 2 diabetes mellitus and, although preventable, it remains a frequent and lifethreatening complication. If a patient has elevated bgl and ketones but is not acidotic they need to be closely monitored and agressively managed to prevent progression to dka. You may be advised to test for ketones in your blood or urine as part of sickday rules. Full text management of adult diabetic ketoacidosis dmso. The management of adults with diabetes undergoing surgery and elective procedures. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus.
Target audience this educational activity has been designed to meet the educational needs of pharmacists and registered nurses involved in the management of patients with diabetes. The management of diabetic ketoacidosis in adults pdf. Dka occurs most frequently but not exclusively in people with type 1 diabetes mellitus, who are absolutely insulindeficient. Emergency management of diabetic ketoacidosis in adults. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults.
Scroll down to read the article or download a printfriendly pdf. Mental status and ph and serum bicarbonate levels help clinicians determine the extent of disease severity, classifying patients as having mild, moderate, or severe dka table 4. Intravenous fluid by bmj knowledge centre citation ends. Dka diabetic ketoacidosis hyperosmolar syndrome hhs hyperglycemic for adults with type diabetes sick day management for children with type diabetes sick day management m oh o oh oh o oh oh o oh what is dka. Diabetic ketoacidosis dka is a rare yet potentially. 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 technology. Ispad clinical practice consensus guidelines 2018 external link opens in a new window. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. To investigate the diabetic ketoacidosis dka episodes occurred in diabetic adults and adolescents. Table 1 outlines the diagnostic criteria for dka and hhs.
Guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. Management of diabetic ketoacidosis in adults queensland health. A persons breath may develop a specific fruity smell. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs are acute severe metabolic complications of uncontrolled diabetes mellitus. The management of the hyperosmolar hyperglycaemic state in. Hyperglycemic crises in adult patients with diabetes. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Management of diabetic ketoacidosis in adults clinical. Older adults and individuals who have comorbid risk factors are in the highest risk category.
Management of diabetic ketoacidosis figure caption and citation for the preceding image starts. Joint british diabetes societies for inpatient care group. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Click on the image or right click to open the source website in a new browser window. Diabetic ketoacidosis information for the public type. Diabetic ketoacidosis guidelines bmj best practice. Weve helped produce the management of diabetic ketoacidosis in adults, pdf, 4mb published by the joint british diabetes societies inpatient car. Management of diabetic ketoacidosis and hyperglycemic. Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs.
Management of diabetic ketoacidosis in adults nursing times. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. Download the management of diabetic ketoacidosis in adults book pdf free download link or read online here in pdf. Acidosis occurs when ketone levels exceed the bodys buffering capacity figure. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. While they may each be seen in pure form, features of the two disorders may also coexist. The full text of this article is available as a pdf 85k. The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management of diabetic ketoacidosis dka and hyperosmolar hyperglycaemia state. The breakdown of fatty acids lipolysis produces ketone bodies ketogenesis, which are acidic. These images are a random sampling from a bing search on the term diabetic ketoacidosis management in adults. The management of diabetic ketoacidosis in adults action 1. Very thirsty frequent urination nausea and vomiting drowsy deep breathing fruity smell to the breath stomach pain coma if not treated. Developments in the management of diabetic ketoacidosis in.
Diabetic ketoacidosis treatment algorithm bmj best. Management of adult diabetic ketoacidosis aidar r gosmanov,1 elvira o gosmanova,2 erika dillardcannon3 1division of endocrinology, diabetes and metabolism, 2division of nephrology, department of medicine, 3department of microbiology, immunology, and biochemistry, university of tennessee health science center, memphis, tn, usa abstract. Joint british diabetes societies inpatient care group. It has been benchmarked against joint british diabetes societies jbds guidance, to. Selected references these references are in pubmed. High blood glucose hyperglycaemia that is not treated can lead to a serious condition called diabetic ketoacidosis or dka for short. This may not be the complete list of references from this article. Both diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are medical emergencies that require prompt recognition and management the initial evaluation of patients.
Ketoacidosis is a serious complication of diabetes. Hospital physician march 2008 21 d iabetic ketoacidosis dka is a serious and potentially lifethreatening complication of diabetes mellitus. Management of diabetic ketoacidosis in adults clinical guideline v4. Joint british diabetes societies guideline for the management of diabetic ketoacidosis. They are potentially lifethreatening and require swift recognition and treatment. This guideline is for the management diabetic ketoacidosis dka in adults and adolescents admitted under adult medical care only. 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. Diabetic ketoacidosis sick day management for adults with type 1 diabetes sick day management for children with type 1 diabetes dka symptoms of dka. Management of diabetic ketoacidosis in adults age 16. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. Management of diabetic ketoacidosis and hyperosmolar. Diabetic ketoacidosis dka, a lifethreatening complication of type 1 diabetes, is preventable but errors in the way it is managed are common and and associated with significant morbidity and mortality.
This guideline describes the management of patients who present to a wa country health service wachs south west sw hospital with diabetic ketoacidosis dka. Diagnosis, management and the importance of prevention. Diabetic ketoacidosis dka management algorithm adult patients. The management of diabetic ketoacidosis in adults external link opens in a new window. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. Figure caption and citation for the preceding image starts. Clinical features, evaluation, and diagnosis view in chinese kussmaul respirations. The management of diabetic ketoacidosis in adults pdf 2m b order reference. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Read online the management of diabetic ketoacidosis in adults book pdf free download link book now.
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