scholarly journals Comparing the Efficacy of a Nurse-Driven and a Physician-Driven Diabetic Ketoacidosis (DKA) Treatment Protocol

2021 ◽  
Vol Volume 13 ◽  
pp. 197-202
Author(s):  
Takla R Anis ◽  
Marybeth Boudreau ◽  
Tyson Thornton
Keyword(s):  
Diabetic Ketoacidosis ◽  
Treatment Protocol

scholarly journals Treatment of Pediatric Diabetic Ketoacidosis in Canada: A Review of Treatment Protocols from Canadian Pediatric Emergency Departments

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Steven A Skitch ◽  
Rahim Valani
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Treatment Guidelines ◽  
Treatment Protocol ◽  
Serum Glucose ◽  
National Guidelines ◽  
Fluid Bolus ◽  
Treatment Protocols ◽  
Maintenance Fluid ◽  
Potassium Replacement

ABSTRACTObjectiveDiabetes is the most common pediatric endocrine disorder, and diabetic ketoacidosis (DKA) is the leading cause of diabetes-related morbidity and mortality. This article reviews pediatric DKA treatment protocols from across Canada and identifies similarities and differences.MethodsPediatric tertiary centres in Canada were asked for a copy of their DKA treatment protocol. For each protocol, we collected information on the amount of initial fluid bolus, maintenance fluid rate, insulin infusion rate, potassium replacement, monitoring and adjustment for serum glucose, administration of bicarbonate, and treatment for cerebral edema.ResultsResponses were obtained from 13 sites. Treatment guidelines were consistent in their recommendations on timing and dosage of intravenous insulin, potassium replacement, monitoring and adjusting for serum glucose, and management of cerebral edema. Variability in treatment protocols was found chiefly in volume of initial fluid bolus (range: 5–20 mL/kg) and length of time boluses should be administered (20–120 min), maintenance fluid rates (based on weight or a 48-hr deficit), and the role of bicarbonate administration.ConclusionsThis is the first review of treatment protocols for pediatric DKA in Canada. It identified many common approaches but noted specific differences in fluid boluses, maintenance fluid rates, and bicarbonate administration. The extent of variation indicates the need for further study, as well as national guidelines that are evidence-based and consistent with best practices.

scholarly journals Identifying risk factors for development of diabetic ketoacidosis in type 1 diabetes mellitus

2019 ◽  
Vol 6 (2) ◽  
pp. 769
Author(s):  
G. Anand Kumar ◽  
Rajendran . ◽  
Swaminathan .
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
First Episode ◽  
Treatment Protocols ◽  
Type1 Diabetes ◽  
Type1 Diabetes Mellitus

Background: DKA [ Diabetic keto acidosis] It is the commonest cause of diabetes-related death in children. Children with diabetic ketoacidosis at diagnosis have poorer glycemic control, to identify the risk factors for the development of Diabetic Ketoacidosis in Type1 Diabetes Mellitus in a tertiary care center.Methods: The study was conducted in Kovai Medical Centre And Hospital Coimbatore in 2018.22 children were included in present study. Each consultant followed different standard DKA treatment protocols. The two protocols used were Milwaukee and BSPED guidelines.Results: Among the 22 children, 3 children (13%) had recurrent DKA (>1 episode). One child had his third episode and the rest 2 children had their second episode.19 children had their first episode of DKA.Conclusions: There was no death among the 22 children treated. This was because of the care is given by the team of doctors and adherence to treatment protocol (Milwaukee or BSPED) of DKA.

scholarly journals Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

2017 ◽  
Vol 5 (1) ◽  
pp. e000395 ◽  
Author(s):  
Iqbal Munir ◽  
Ramiz Fargo ◽  
Roger Garrison ◽  
Almira Yang ◽  
Andy Cheng ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Conventional Treatment ◽  
Treatment Protocol ◽  
System Versus

scholarly journals Potassium-Containing Fluids for Diabetic Ketoacidosis

2021 ◽  
Vol 26 (6) ◽  
pp. 592-596
Author(s):  
Rebecca Guise ◽  
Kari Ausherman ◽  
Turaj Vazifedan
Keyword(s):  
Diabetic Ketoacidosis ◽  
Serum Potassium ◽  
Potassium Concentration ◽  
Point Of Care ◽  
Treatment Protocol ◽  
Potassium Phosphate ◽  
Retrospective Chart Review ◽  
Potassium Acetate ◽  
Improvement Project ◽  
Serum Potassium Concentration

OBJECTIVE The purpose of this process improvement project was to determine the appropriate potassium concentration of stocked IV fluids used in the treatment of diabetic ketoacidosis (DKA) at the Children's Hospital of The King's Daughters (CHKD) Emergency Department. METHODS This is a retrospective chart review from July 1, 2018, through June 30, 2019. Patients ≤21 years of age with laboratory-confirmed DKA were included. The primary outcome was to determine the most used potassium concentration (20 mEq/L or 40 mEq/L) for stocked IV fluids. Secondary efficacy and safety outcomes included the percent of appropriately ordered fluids per the DKA treatment protocol, percent of patients who maintained goal serum potassium concentration, comparison of time from physician ordering to administration of prescribed IV fluids (t-elapsed), and comparison of serum potassium concentrations between the point of care (POC) test and basic metabolic panel (BMP). RESULTS Of the 113 patients included, 73 (64.6%) received 40 mEq/L, 7 of whom received half potassium acetate plus half potassium phosphate, and 40 (35.4%) received 20 mEq/L potassium IV fluids. In 101 patients (89.4%), fluids were ordered appropriately per protocol. Of these patients, 53 (52.5%) maintained goal serum potassium concentration. The t-elapsed from physician ordering to administration of the prescribed fluid concentrations was not statistically significant. The mean POC versus BMP potassium concentration was statistically significant (4.56 mmol/L versus 4.96 mmol/L, respectively; 95% CI: −0.49 to −0.30; p < 0.001). CONCLUSIONS The CHKD pharmacy should stock the most used 40 mEq/L potassium IV fluids for DKA treatment.

479: SUCCESSFUL IMPLEMENTATION OF A TREATMENT PROTOCOL FOR DIABETIC KETOACIDOSIS

2016 ◽  
Vol 44 (12) ◽  
pp. 196-196
Author(s):  
Megan Van Berkel ◽  
Jocelyn Joseph ◽  
Heidi Riha ◽  
Cortney Swiggart
Keyword(s):  
Diabetic Ketoacidosis ◽  
Treatment Protocol ◽  
Successful Implementation

scholarly journals Prolonged diabetic ketoacidosis associated with canagliflozin

2018 ◽  
Vol 2018 ◽  
Author(s):  
Gordon Sloan ◽  
Tania Kakoudaki ◽  
Nishant Ranjan
Keyword(s):  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Cell Function ◽  
Treatment Protocol ◽  
List Type ◽  
Excessive Alcohol Consumption ◽  
Treatment Regimens ◽  
Glucose Levels ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate

Summary We report a case of a 63-year-old man who developed diabetic ketoacidosis (DKA) associated with canagliflozin, a sodium glucose co-transporter 2 (SGLT-2) inhibitor. He presented acutely unwell with a silent myocardial infarction, diverticulitis and DKA with a minimally raised blood glucose level. Standard therapy for DKA was initiated. Despite this, ketonaemia persisted for a total of 12 days after discontinuation of canagliflozin. Glucosuria lasting for several days despite discontinuation of the medications is a recognised phenomenon. However, this is the longest duration of ketonaemia to be reported. The cause of prolonged SGLT-2 inhibition remains uncertain. Deviation from the normal DKA treatment protocol and use of personalised regimens may be required in order to prevent relapse into ketoacidosis while avoiding hypoglycaemia in those that develop this condition. Learning points: Diabetic ketoacidosis (DKA) may develop in the presence of lower-than-expected blood glucose levels in patients treated with a sodium glucose co-transporter 2 (SGLT-2) inhibitor. Certain individuals prescribed with SGLT-2 inhibitors may be more at risk of DKA, for example, those with a low beta cell function reserve, excessive alcohol consumption and a low carbohydrate diet. In order to reduce the risk of SGLT-2 inhibitor-associated DKA, all patients must be carefully selected before prescription of the medication and appropriately educated. Increased serum ketone levels and glucosuria have been reported to persist for several days despite discontinuation of their SGLT-2 inhibitor. Physicians should consider individualised treatment regimens for subjects with prolonged DKA in the presence of SGLT-2 inhibition.

scholarly journals 1094 Diagnosis of Diabetic Ketoacidosis Delayed Due to Concomitant Acute-On-Chronic Pancreatitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Lung
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Epigastric Pain ◽  
Treatment Protocol ◽  
Abdominal Sepsis ◽  
Arterial Blood Gas ◽  
Glucose Levels ◽  
Arterial Blood ◽  
Dual Diagnoses

Abstract The objective of this clinical case is to highlight the importance of recognition and prompt management of diabetic ketoacidosis (DKA) in older patients with comorbidities such as acute pancreatitis. A 61-year-old gentleman initially presented to the hospital with severe left upper quadrant/epigastric pain and vomiting. He had a background of chronic pancreatitis, diabetes secondary to pancreatitis and alcohol excess. Based on his raised inflammatory markers and CT findings which showed pancreatic pseudocyst compressing on the spleen, a diagnosis of acute-on-chronic pancreatitis and possible intra-abdominal sepsis was made. He was subsequently commenced on piperacillin with tazobactam and given fluids. His abdominal pain persisted despite initial treatment. His blood glucose levels were within normal range, but his ketone levels were found to be consistently high since admission. Two days later, he presented with reduced consciousness and generalised abdominal tenderness; his arterial blood gas showed a very severe metabolic acidosis. A diagnosis of DKA was then made – he was commenced on the DKA treatment protocol and was transferred to the Intensive Care Unit for stabilisation. He gradually made a recovery and was later transferred from the ICU to the endocrinology ward. DKA usually presents in younger patients with type 1 diabetes. Given the background of this patient, his presentation was largely attributed to a surgical cause. Clinicians must remain alert to the possibility of dual diagnoses relating to abdominal pain, which in this case were a surgical cause (pancreatitis) and a medical cause (DKA).

Multiple Ischemic Infarctions, Pulmonary Edema, and Acute Renal Failure During an Episode of Diabetic Ketoacidosis in an Adult

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 85-90
Author(s):  
Rahul K. Mishra ◽  
Kenneth M. Nugent ◽  
Nabeel Dar ◽  
Joaquin Lado-Abeal
Keyword(s):  
Renal Failure ◽  
Inflammatory Response ◽  
Pulmonary Edema ◽  
Diabetic Ketoacidosis ◽  
Time Course ◽  
Treatment Protocol ◽  
Systemic Inflammatory Response ◽  
X Rays ◽  
Altered Level ◽  
Treatment Standard

The morbidity and mortality associated with diabetic ketoacidosis (DKA) often reflects the precipitating events, such as myocardial infarction. However, DKA can trigger a systemic inflammatory response with the potential for multiple complications. This 30-year-old woman with type 1 diabetes mellitus improved within 48 hours of admission with a standard DKA treatment protocol. However, subsequent chest X-rays revealed bilateral infiltrates consistent with pulmonary edema; she then developed fever, hypotension, and acute-on-chronic renal failure. An altered level of consciousness prompted evaluation with neuroimaging, which revealed ischemic infarcts in the right frontal, parieto-occipital, and temporal cortices and cerebellum correlating with a left-sided hemiparesis. This case illustrates the potential complexity in the pathogenesis and management of patients with DKA. This patient likely had a systemic inflammatory response syndrome with multiorgan failure during this episode of DKA. Patients with DKA need risk stratification for comorbid diseases on presentation and attention to vital signs, especially unexplained fever, evolving neurologic symptoms, and respiratory symptoms during the hospital course. This information can help dictate the time course for treatment; standard treatment protocols for patients with DKA may create a false sense of security in complex patients.

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