We know DKA is a complication of uncontrolled diabetes mellitus . it may be due to,
In DIABETIC KETTO ACIDOSIS,the level of glucose in the blood will be high,increasing the osmolarity of the blood.It causes the shift of fluid from tissues into the intravascular place,causing dehydration at the tissue level.So if we give the insulin through sub cutaneous route,it will be poorly absorbed as the tissues are poorly perfused.So it is better to give insulin via IV route. In DKA,as dehydration is at the tissue level ,not at the vascular level, in most cases,urinary out put will be high.
In DKA,we give insulin through intravenous route.A bolus of insulin(0.15u per Kg ) is given,followed by an infusion of 5-10u per hour(0.1u per Kg per hour).During preparation of infusion ,first fill the iv tubing with fluid,then add insulin, to prevent adhesion of insulin to the tubings.
During insulin therapy, Blood glucose level should be monitored every 30min in order to maintain RBS around 250mg/dl for the first 12 to 24 hours.For this purpose ,a 5 percent dextrose solution can be added to the infusion.This is to prevent development cerebral edema ,from rapid. correction of hypoglycemia.With improvement of condition,discontinue iv insulin ,and start subcutaneous insulin at 0.2u per Kg .But it has to be given 15 to 30 min before stopping iv insulin.
One of the problem with insulin therapy is that, it causes hypokalemia, as insulin stimulate the Na -K pump ,causing influx of potassium ions.So correct blood potassium levels ,and give food rich in potassium.But potassium correction has to be done with an eye on the urinary output too.This is because,If the output is low, there will be a chance of hyperkalemia, in which no potassium correction is needed.
Other management includes fluid therapy with isotonic normal saline 1000ml for the first hour and then 2000-8000ml over the 24 hours.
Thank you very much.....
1 too little insulin dose
2 skipping doses of insulin
3 conditions causing increased need such as surgery,trauma,pregnancy,stress,puberty,infection etc
4 increased peripheral insulin resistance
In DIABETIC KETTO ACIDOSIS,the level of glucose in the blood will be high,increasing the osmolarity of the blood.It causes the shift of fluid from tissues into the intravascular place,causing dehydration at the tissue level.So if we give the insulin through sub cutaneous route,it will be poorly absorbed as the tissues are poorly perfused.So it is better to give insulin via IV route. In DKA,as dehydration is at the tissue level ,not at the vascular level, in most cases,urinary out put will be high.
In DKA,we give insulin through intravenous route.A bolus of insulin(0.15u per Kg ) is given,followed by an infusion of 5-10u per hour(0.1u per Kg per hour).During preparation of infusion ,first fill the iv tubing with fluid,then add insulin, to prevent adhesion of insulin to the tubings.
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| GLUCOMETER |
During insulin therapy, Blood glucose level should be monitored every 30min in order to maintain RBS around 250mg/dl for the first 12 to 24 hours.For this purpose ,a 5 percent dextrose solution can be added to the infusion.This is to prevent development cerebral edema ,from rapid. correction of hypoglycemia.With improvement of condition,discontinue iv insulin ,and start subcutaneous insulin at 0.2u per Kg .But it has to be given 15 to 30 min before stopping iv insulin.
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| SELF ADMINISTRATION |
One of the problem with insulin therapy is that, it causes hypokalemia, as insulin stimulate the Na -K pump ,causing influx of potassium ions.So correct blood potassium levels ,and give food rich in potassium.But potassium correction has to be done with an eye on the urinary output too.This is because,If the output is low, there will be a chance of hyperkalemia, in which no potassium correction is needed.
Other management includes fluid therapy with isotonic normal saline 1000ml for the first hour and then 2000-8000ml over the 24 hours.
Thank you very much.....
hi, is it good to have a diet high in k+ as K+ is not lost from the body. While giving insulin only a shift occour due to the activation of the na+ k+ pump and moreover by the time when the sugar level comes down, is there any chance for the client to go futher life threatening condition of hyperkalemia if we provide a k + rich diet in the begining to prevent hypokalemia.
ReplyDeletethats why we do GIK( glucose in Kcl) infusions via pump,,,,,,and sugar monitoring hourly,,,,,,
ReplyDeletewell said man. hypokalemia should be corrected as it May lead to cardiac instability and life threatening arythmias.when the blood glucose and insulin levels are normal,the electrolytes levels will be maintained at the normal range through the homeostasis mechanism of the body.well said man. hypokalemia should be corrected as it May lead to cardiac instability and life threatening arythmias.when the blood glucose and insulin levels are normal,the electrolytes levels will be maintained at the normal range through the homeostasis mechanism of the body.
ReplyDelete