Management of DKA?

INSULIN THERAPY,INTRAVENOUS ADMINISTRATION OF FLUIDS,CHECK FOR KETON EBODIES IN URINE ,KUSSMALS RESPIRATION,VITAL SIGNS MONITERING

Fluid correction with Normal saline

urin test for ketons

monitor for Kassmaul respiration

monitor for Hyperglycemia above 240mg dl

informed the doctor

fluids correction

managing potassium levels

managing hypo and hyperglycemia

• Correction of fluid loss with intravenous fluids
• Correction of hyperglycemia with insulin
• Correction of electrolyte disturbances, particularly potassium loss
• Correction of acid-base balance
• Treatment of concurrent infection, if present

MODIFIED MILWAUKEE REGIMEN.

CORRECTION OF HYDRATRION, MANAGEMENT OF DYSELECTROLYTEMIAS, MONITORING NEUROSENSORY FUNCTIONS. 

CONITNUOUS INSULIN INFUSION/NS/MANAGE HYPERKALEMIA/HYDRATION CORRECTION/

SWITCH ON TO INTERMITTENT INFUSION OF INSULIN+DIETARY PRESCRIPTION

IV infusions of 0.9% or 0.45% of saline as ordered

moniotr electrolytes especially potassium level closely

monitor vital signs,urine output and mental status

assesment of general condition of the patient ABC, insert 2 wide bore canulaes and withdraw( RBS, ABG, KFT, CBCm CRPm HbA1c), start shock therapy by normal saline in the ER  unitm check aceton in urine then transfere the patient to PICU. start Insulin infusion (full drip m half drip) according to RBS, ABG, Aceton in urin.

Calculate serum osmolarity to determine the total duration of infused insulin drip

monitor RBS/ Hr, acetone in urine/6 Hrs, ABG/ 12Hr.

after RBS normailzation start Insulin SC overlapping with infused insulin and start oral feeding to determine the corrected Insulin SC dose ( 3 doses short acting + one dose long lasting) 

• Correction of fluid deficits.

• Treatment hyperglycemia by insulin.

• Correction of electrolyte disturbance.

Correction of fluid deficits should be undertaken gradually over 12 to 24 hours in ICU is advisable.

Correction of hyperglycemia by regular insulin better to be by insulin pump.

Correction of electrolyte disturbance.Particularly potassium loss.

Correction of acid base imbalance if PH below 7.1.

Treatment of infection if present.