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Informatics in Pharmacy

Ketoacidosis

August 12, 2018 By Dr. G, PharmD

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Ketoacidosis is more common in type 1 diabetes than in type 2.  The goal treatment is to stop ketosis, not to normalize glucose.

Common symptoms: polyuria, polydipsia, vomiting, dehydration, weakness, altered mental status, coma, abdominal pain, Kussmaul respirations, tachycardia, hyponatremia, hyperkalemia

Treatment:

  1. Fluid replacement: start with 0.45-0.9% NS, change to 5% dextrose or dextrose containing saline when glucose is less than 200 mg/dl.
  2. Correct serum sodium(for every 100mg/dL increase over 100 in glucose, increase sodium by 1.6).  Usually, 0.9% NS, do not rapidly correct sodium ever.
  3. If potassium is less 3.3 mEq/L, replace KCl before giving insulin.
  4. Insulin: 0.1 unit/kg bolus and then infusion ONLY if KCl is greater than 3.3 mEq/L.  Keep glucose 150-200 mg/dl until DKA resolves.
  5. If pH <= 6.9 – Give bicarb over 1-2 hours
  6. DKA is resolved when serum glucose is less than 200 and 2 of the following:
    Venous pH >  7.3
    Bicarb 15 mEq or greater
    Anion gap of 12 mEq or less

If you prefer charts, here’s one I downloaded for my notes.

Filed Under: Endocrine Disorders Tagged With: acidosis, diabetes

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020