 Diabetic Ketoacidosis
Treatment
Diabetic
Ketoacidosis
Treatment
When someone is
drowning, it is no time to tell him or her, how to swim
and this particularly is very important in view of the
critical nature and crucial importance of diabetic
ketoacidosis treatment. The first thing therefore is to
check the vital signs, if the patient has been admitted
in a state of coma and to ensure adequate ventilation,
sufficient supply of oxygen and unobstructed air paths.
In case the patient can be aroused, it would be opportune
to take history, as it would be valuable in correct
diagnosis and determining the right course of
treatment.
Strategy of
treatment
Taking in
consideration, the impacts of any lacunae during diabetic
ketoacidosis treatment, It is important to follow the
standard protocol conscientiously but not in a robotic
manner.
Proceeding of
treatment
-
Ketoacidosis
follows hyperglycemia or high blood sugar level
resulting in excessive loss of water and glucose. The
slightest signs of dehydration must not be overlooked
and to make up volume deficit should be treated as
top priority matter. Correction of
fluid loss is the
most important corrective and preventive action. It
may be achieved through interveinous
dispensation.
An isotonic solution like 0.9% isotonic
saline may be administered for the purpose. The process
needs to be continued and adjusted in accordance with the
rate of dehydration. In addition to the chemical tests
some physical examination like skin turgor also indicates
the rate of improvement. Although standard protocol for
the situation is available to all the concerned, yet it
is the medical professional and in charge at the helm of
affairs whose directions must be closely followed even if
they might sometimes appear in suppression of the
standard protocol.
-
Correction of
ketosis and acidosis are next only to the makeup of
volumetric deficit. Correct determination of pH is very
important as any misreading in this respect may put you
off-track and instead of curing may lead to an action that
can be harmful. A pH lower than 7.3 is regarded critical
and effort should be made to raise it to about 7.1. Only
colorimetric testing, using indicator strips etc. should
not be relied upon.
-
Makeup of
electrolyte deficit is the next action to be taken.
Dehydration is almost always associated with loss of
electrolytes which need prompt make up for early and
complete recovery.
-
Insulin
Therapy is the crux of diabetic
ketoacidosis treatment. In its administration to DKA
patients, starting with low dose of insulin is
advisable as precaution against possible hypoglycemia
(low blood sugar level).On account of excessive fluid
loss, subcutaneous administration of insulin is less
effective, hence intramuscular or intravenous routes
are advisable.
-
Cerebral
edema: is a complication that must be
watched very carefully during treatment of DKA
particularly in children suffering from
DM1.
-
End note ,on
discharge: Examine the patient to review the
degree of recovery and ensure that pH has exceeded 7.3
and carbonate is more than 18
mEq/L while blood glucose level should be in the range of
100-180 mg/dL
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