DKA

[wesam]

• Diabetic Ketoacidosis :
 Confirm the diagnosis (Blood Glucose > 300 mg/dl ,PH <7.35 plus Ketosis ) .
 Record the vital signs.
 Insert an I.V cannula .
 Draw blood for blood sugar, serum electrolytes ,blood urea and complete Haemogram ) .
 Insert a Foley's catheter .
 Measure Arterial blood gases .
 Start I.V fluids Normal Saline , one liter per hour.
 Start soluble Insulin give 20 units I.V followed by 5 to 10 units I.V hourly preferably as an infusion .
 Measure blood sugar and serum k+ hourly .
 Give k+ supplement when the level is normal (40 mmol per liter )
 Change I.V fluids to Dextrose Saline when blood sugar approaches 250 mg/dl (14 mmol/l )
 Continue I.V Insulin till ketosis disappear .
 Bicarbonate is given when acidosis is sever ( PH < 7.0 ) and not corrected by the above measures .

• Hyperosmolar Non-ketotic Coma :
 Complication of Diabetes type 2 .
 Osmolaity is greater than or equal to 320 mOsm/l .
 Treatment is similar to that of ketoacidosis .
 Rehydration and treatment of hyperglycaemia is slower .
 Do blood and CSF culture .
 Give Intravenous Heparin .