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Step 1:: Insulin Therapy

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14 views

Step 1:: Insulin Therapy

Uploaded by

ahmedmahmoudxd2001
Copyright
© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
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Algorithm for Managing Diabetic Ketoacidosis (DKA)

Step 1: Initial assessment and stabilization


 Evaluate the patient's airway, breathing, and circulation (ABCs)
 Administer supplemental oxygen if needed
 Establish intravenous (IV) access for fluid and medication administration
 Begin cardiac monitoring and continuous pulse oximetry
Step 2: Fluid resuscitation
 Start with a bolus of 0.9% saline solution (15-20 mL/kg) over the first hour
 Follow with a continuous infusion of 0.9% saline at a rate of 250-500 mL/hour until hemodynamic
stability is achieved
 Monitor vital signs, urine output, and electrolyte levels closely during fluid resuscitation
Step 3: Insulin therapy
 Initiate a regular insulin infusion at a rate of 0.1 units/kg/hour after the initial fluid bolus
 Continue regular insulin infusion until resolution of DKA (anion gap closes, blood glucose <200
mg/dL, and bicarbonate >18 mEq/L)
 Monitor blood glucose levels hourly and adjust insulin infusion rate accordingly
Step 4: Electrolyte replacement
 Measure serum potassium levels before initiating insulin therapy
 If potassium level is normal or low, add potassium chloride to IV fluids at a rate of 20-30 mEq/L
 If potassium level is high, withhold potassium supplementation until levels normalize
 Monitor potassium levels every 2 hours initially, then every 4 hours once stable
Step 5: Bicarbonate therapy (optional)
 Consider administering sodium bicarbonate if arterial pH is <6.9 or if severe acidemia is present
 Administer bicarbonate slowly as a continuous infusion to avoid rapid shifts in pH
 Monitor arterial blood gases and electrolytes closely during bicarbonate therapy
Step 6: Identification and treatment of precipitating factors
 Determine the underlying cause of DKA (e.g., infection, noncompliance with insulin, pancreatitis)
 Treat the underlying cause with appropriate interventions (e.g., antibiotics for infection, insulin
therapy optimization)
 Provide education and counseling to prevent future DKA episodes
Step 7: Transition to subcutaneous insulin therapy

 Once DKA is resolved, transition from intravenous insulin infusion to subcutaneous insulin
injections or an insulin pump
 Start with basal insulin and gradually introduce mealtime insulin as needed
 Provide education on self-monitoring of blood glucose, insulin administration, and sick day
management

Step 8: Close monitoring and follow-up


 Monitor blood glucose levels regularly, especially during periods of illness or stress
 Schedule regular follow-up visits to assess glycemic control and adjust treatment as necessary
 Provide ongoing education & support to promote self-management and prevent DKA recurrence.

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