Diabetic ketoacidosis dka 1 free download as powerpoint presentation. Presentation pdf available january 2014 with 440 reads. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic ketoacidosis symptoms and causes mayo clinic.
Noblebell g, cox a 2014 management of diabetic ketoacidosis in adults. The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. The discovery of insulin in 1922 heralded a new age in enabling long. The common clinical presentation of dka and hhs is due to. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The biochemical criteria for the diagnosis of diabetic ketoacidosis. Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Sugar is a main source of energy for the cells that.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the most commonly encountered diabetic decompensation emergencies. Discuss dka presentation assessment treatment i have no. A brief overview of diabetes and the american diabetes association. Diabetic ketoacidosis dka, though preventable, remains a frequent and life threatening complication of. This article explores the pathophysiology and initial assessment and treatments which are. Discuss dka presentation assessment treatment i have no financial disclosures. Diabetic ketoacidosis treatment guidelines ppt it is a collaborative process in which diabetes educators help people with or at risk for diabetes gain the knowledge and problemsolving and coping skills needed to successfully selfmanage the disease and its related conditions. Hospitalizations for diabetic ketoacidosis as firstlisted diagnosis in adults with diabetes, united states.
Viktor rosival synlab, department of laboratory medicine, derers hospital, bratislava, slovakia in the article management of adult diabetic ketoacidosis by gosmanov et al1 there are some. Practice guidelines resources american diabetes association. Insulin deficiency is the main precipitating factor. Sglt inhibition and euglycaemic diabetic ketoacidosis.
When sglt2 inhibitors are combined with insulin, it is often necessary to decrease the insulin dose to avoid hypoglycemia. They include increased thirst and urination, hunger, weight loss, dry skin, and sometimes blurred vision. 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. Diabetic ketoacidosis in pregnancy tends to occuratlowerbloodglucoselevels. May 17, 2018 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. Diabetic ketoacidosis is an acute metabolic emergency, and affected patients most commonly present with hyperglycemia, anion gap metabolic acidosis, and hyperketonemia. Clinical presentation and laboratory investigations usually provide the infor mation needed to diagnose dka. Diabetic ketoacidosis dka is an extreme metabolic state caused by. The presentation of dka varies with severity and comorbid conditions. Sglt2 inhibitors may predispose to ketoacidosis the journal. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. He has been treated with an intensive insulin regimen. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic ketoacidosis an overview sciencedirect topics.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. The 2020 standards of medical care in diabetes includes all of adas current clinical practice recommendations and is intended to provide clinicians, patients, researchers, payers, and others with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes. More than 50% of diabetic ulcers become infected and 20% of those w moderatesevere infection result in amputation. Although rehydration alone can cause partial correction of hyperglycemia, insulin is required to. Diabetes book free pdf ebook was written by designtype on february 24 2000 consist of 96 pages also i was able diabetes diet menu to make a personal connection with the interviewer we are both avid homebrewers so i know the management of diabetic ketoacidosis in adults mar 2014 that was a plus. Georgia noblebell and alison cox are diabetes specialist nurses at kings college hospital, london.
Diabetic foot ulcerations are one of the most common complications associated w diabetes with a global annual incidence of 6. Current management of diabetes mellitus and future. If you continue browsing the site, you agree to the use of cookies on this website. The guide was developed by the international diabetes federation and the fred hollows foundation, and builds upon the ico guidelines for diabetic eye care. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Diabetic ketoacidosis dka care guidelines emergency.
The complete set of guidelines can be found for free download at. Significant evidence exists that supports a range of interventions to improve diabetes. Diabetic ketoacidosis emergency condition of nausea, vomiting, dehydration. Diabetic ketoacidosis management in adults nursing times. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Ppt diabetic ketoacidosis powerpoint presentation free. Diabetic ketoacidosis dka is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 35%. Diabetic ketoacidosis symptoms, diagnosis and treatment. Because there is considerable individual variability in presentation of dka ranging from mild.
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. Dec 26, 2017 case study 1 a 32yearold male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Sglt2 inhibitors trigger multiple mechanisms that could predispose to diabetic ketoacidosis. While it occurs predominantly in type 1 diabetic patients, at the time of diagnosis, it can also happen in type 2 diabetes when medications are inadequately managed. Fever and cough started 2 days ago and the patient could not eat or drink water. There is excess production of ketoacids due to a lack of insulin. Symptoms dka physical findings can be the first dehydration hypotension presentation. This article is published with open access at abstract. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Sglt2 inhibitors may predispose to ketoacidosis the.
Diabetic ketoacidosis intravenous therapy blood sugar. Dec 11, 2019 you have multiple signs and symptoms of diabetic ketoacidosis excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruityscented breath, confusion. An update of its etiology, pathogenesis and management ebenezer a. Case study 1 a 32yearold male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. In both syndromes, there is insufficient insulin levels to transport. Abstract noblebell g, cox a 2014 management of diabetic ketoacidosis in adults. Diabetic ketoacidosis it is a life threatening but reversible complication of type 1 diabetes due to absolute insulin deficiency. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs remain two of the most commonly encountered metabolic emergencies. Current management of diabetes mellitus and future directions. In conclusion, although ketoacidosis is not a common adverse event in sglt2 inhibitortreated patients, the fda has issued a formal warning that this class of drugs may indeed increase the risk of diabetic ketoacidosis dka. If not diagnosed and treated with insulin, the person with type 1 diabetes will eventually develop a lifethreatening condition known as diabetic ketoacidosis keytoeasidoesis or dka. Argy resident february, 2007 diabetic ketoacidosis dka a state of absolute or relative insulin deficiency aggravated.
Remember, untreated diabetic ketoacidosis can be fatal. This article outlines updates in the clinical management of. Whether intravenous fluids contribute to these injuries has been debated for decades. Treatment of diabetic ketoacidosis dkahyperglycemic. Scroll down to read the article or download a printfriendly pdf. The management of diabetic ketoacidosis in adults mar 2014. Nurse practitioners are well positioned to promote patient education, selfmanagement, and individualized patient care. Scribd is the worlds largest social reading and publishing site. This guide encourages and facilitates good diabetes management, early diagnosis and treatment of diabetic eye disease, as well encouraging integration and cooperation across the health system. Cox are diabetes specialist nurses at kings college hospital, london. Diabetic ketoacidosis dka accounts for 8% to 29% of all primary diabetic admissions to a hospital, thus contributing to high costs of care for children with type 1 diabetes mellitus. The lifetime incidence of foot ulcers in diabetic patients is 19 34%.
Diabetic ketoacidosis and hyperosmolar crisis in adults. Symptoms dka physical findings can be the first dehydrationhypotension presentation. High anion gap metabolic acidosis due to excessive blood concentration of ketone bodies ketoanion. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. It is important to remember that not all patients who.
Jahangir moini md, mph, in epidemiology of diabetes, 2019. Clinical trial of fluid infusion rates for pediatric diabetic. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. A free powerpoint ppt presentation displayed as a flash slide show on id. Jun 30, 2014 diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%. Initial assessment and treatment of diabetic ketoacidosis. Ongoing patient selfmanagement education and support are critical to preventing acute complications and reducing the risk of longterm complications.
Severe insulin deficiency occurs in previously undiagnosed type 1 diabetes mellitus. Both are caused by a relative or absolute deficiency of insulin and elevated levels of counter regulatory hormones. Kitabchi division of endocrinology, diabetes and metabolism, university of tennessee health science center, 920 madison ave. Diabetic ketoacidosis dka is an acute, severe, and potentially lifethreatening phenomenon that is caused by severe hyperglycemia, in which the blood glucose levels exceed 250 mgdl. Dka onset and recurrence can largely be prevented through patient education. Casecontrolstudyandacasereportof euglycemic diabetic ketoacidosis in pregnancy. Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Diabetic ketoacidosis dka is a medical emergency which affects thousands of people each year in the united kingdom and requires immediate medical attention. It is commonly precipitated by poor adherence to medication, stress and concurrent illness.
Dka occurs most frequently but not exclusively in people with type 1 diabetes mellitus, who are absolutely insulindeficient. Prof maclean of guys hospital wrote in the postgraduate medical journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. Ketoacidosis is a serious complication of diabetes. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. It can also occur in patients with other types of diabetes. Recurrent episodes of diabetic ketoacidosis and hhs can be prevented in many cases. Introduction hhs and dka are not mutually exclusive but rather two conditions that both result from some degree of insulin deficiency. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus. Updates in the management of diabetic ketoacidosis the.
Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Ispad clinical practice consensus guidelines 2014 compendium. They are both potentially lifethreatening when not managed correctly. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes caused by the buildup of ketone bodies secondary to insulin deficiency. Based on your understanding of how glucagon works in the human body, which one of the following is the therapeutic goal of administering it. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3. Diabetic ketoacidosis dka results from deficiency of circulating insulin and increased levels of the counterregulatory hormones. Diabetic ketoacidosis care guideline for emergency department american diabetes association. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Significant evidence exists that supports a range of. Diabetic ketoacidosis and hyperglycemic hyperosmolar state table 1. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment.
125 1551 445 1256 1450 1222 691 1132 205 622 474 69 210 1383 249 632 818 345 548 1513 282 964 402 1448 233 915 330 1543 1552 939 1001 1105 947 178 288 451 1204 333 1164 1289 1084 357