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mohammed-adel
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Introduction
•Definition
•Pathophysiology
•Symptoms
•Diagnostic criteria
•Management
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Definition
• Potentially life-threatening complication in patients with diabetes mellitus.
• It happens predominantly in those with type 1 diabetes as a result from a shortage of insulin.
• The body switches to burning fatty acids and producing acidic ketone bodies that cause most of
the symptoms and complications.
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Pathophysiology
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Symptoms
•Weakness or fatigue
•Shortness of breath
•Fruity-scented breath
•Confusion
•Excessive thirst
•Frequent urination
•Nausea and vomiting
•Abdominal pain
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Diagnostic criteria
• PLASMA GLUCOSE
• >250 mg/dl (>13.9 mmol/L)
• ARTERIAL PH
• 7.25 to 7.3 in mild DKA• 7.00 to <7.24 in moderate DKA• <7.00 in severe DKA
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Diagnostic criteria
• SERUM BICARBONATE
• 15 to 18 meq/L (15 to 18 mmol/L) in mild DKA• 10 to 15 meq/L (10 to 15 mmol/L) in moderate DKA• <10 meq/L (<10 mmol/L) in severe DKA
•URINE AND SERUM KETONES
• Strong positive
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Diagnostic criteria
• ANION GAP
• >10 meq/L (>10 mmol/L) in mild DKA• >12 meq/L (>12 mmol/L) in moderate and severe DKA
•MENTAL STATUS
• Alert in mild DKA• Alert/drowsy in moderate DKA• Coma in severe DKA
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Management
•THE MAIN GOALS OF TREATMENT ARE:
•Restoration of volume deficits•Resolution of hyperglycemia and ketosis/acidosis
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Management
•THE MAIN GOALS OF TREATMENT ARE:
•Correction of electrolyte abnormalities:• (K+ level should be >3.3 mmol/L before initiation of
insulin therapy)•Treatment of the precipitating events and
prevention of complications.
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Management
•THERAPY INCLUDES
•Gradual fluid replacement with:•N.S .9% •D5W (practice based information)
•Correction of electrolyte imbalance
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Management
•THERAPY INCLUDES
•Insulin therapy:•Iv bolus . 0.3 units/kg, followed by 0.2 units/kg 1 hr later,
followed by 0.2 units/kg every 2 hours until blood glucose becomes >250 mg/dL (CHF/MI/ESRF/Pregnancy)
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Management
•THERAPY INCLUDES
•Insulin therapy:•Iv infusion of 0.14 /Kg/hr (10 units /hr in a 70 kg pt) is given. •After exclusion of hypokalemia (potassium <3.3 mEq/L), a
continuous infusion of regular insulin at a dose of 0.1 units/kg per hour is recommended.
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Management
•THERAPY INCLUDES
•Insulin therapy:•This low-dose insulin therapy decreases plasma glucose
concentration at a rate (50 to 75 mg/dL/hour).
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Management
•THERAPY INCLUDES
•Other therapies indicated:•Bicarbonate therapy stills controversial but starts when PH lower than
7•Phosphate correction may be indicated for patients with cardiac
dysfunction with careful monitoring
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