Dka mainly affects people with type 1 diabetes, but can sometimes occur in. It is caused by a deficiency of insulin and elevated levels of counter regulatory hormones. Patients identified with diabetic ketoacidosis during their hospital stay background definitions diabetic ketoacidosis dka is a lifethreatening condition. The use of protocols is an important strategy to expedite care, improve patient flow, and increase patient safety. The decision to administer sodium bicarbonate to a child with dka must be made in consultation with a paediatric intensivist and a paediatric endocrinologist at a level 6 facility. Insulin infusion should be continued until acidosis has resolved, as demonstrated by ph 7. It is treated commonly in the intensive care unit icu, even though clinical data from many studies support management in regular medicalsurgical wards, avoiding expensive critical care unit costs and preventing bed crisis in these higher level. Diabetic ketoacidosis dka, a lifethreatening complication of type 1 diabetes, is preventable but errors in the way it is managed are common and and associated with significant morbidity and mortality. Waddell, dvm, dacvecc diabetic ketoacidosis dka is a one of the most common causes of severe metabolic illness that results in prolonged hospitalization of dogs and cats.
This causes harmful substances called ketones to build up in the body, which can be lifethreatening if not spotted and treated quickly. If a patient has elevated bgl and ketones but is not acidotic they need to be closely monitored and agressively managed to prevent progression to dka. Procedures are adapted for covidrelated considerations of minimizing risk to staff while optimizing patient safety and health. The management of diabetic ketoacidosis in adults march 2010 reflects. Jonathan silverman, md pediatric emergency medicine nursing practice council. Veterinary practice guidelines 2018 aaha diabetes management guidelines for dogs and cats ellen behrend, vmd, phd, dacvim, amy holford, vmd, dacvimy, patty lathan, vmd, dacvim, renee rucinsky, dvm, dabvpy, rhonda schulman, dvm, dacvim abstract diabetes mellitus dm is a common disease en countered in canine and feline medicine. Treatment of hyperglycemia adult hcs20602 procedure. Dka guideline executive summary childrens hospital of richmond at vcu dka workgroup pediatric emergency medicine owner. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus. Patients admitted to icu with dka diabetic ketoacidosis will be monitored and. Almost 1 in 100 children with dka will develop cerebral edema, which has a mortality rate of 2124%. Prebreakfast administer both glargine and aspart dose according to premeal aspart order set.
Guideline title management of diabetic ketoacidosis. Dka guideline for diagnosis hhs guideline for diagnosis. Dka treatment protocol barbara davis center for childhood. The management of diabetic ketoacidosis in adults our. These guidelines are recommended to all diabetes hospital teams for rapid introduction and for acceptance as the national guideline for managing dka. Barbara davis center serves more than 90% of colorado children diagnosed with type 1 diabetes. Management of diabetic ketoacidosis in adults age 16. Phase type of fluid rate iv regular insulin endpointgoal 0. This version autocalculates the fluid rates and has some popup screens to guide in the clinical evaluation of children presenting with dka. The care required is beyond the level of comfort or resources of the local hospital. Treatment protocols for pediatric diabetic ketoacidosis dka vary considerably among centers in the usa and worldwide. Diabetic ketoacidosis is a complication for some patients with insulindependent diabetes mellitus as well as for noninsulin dependent. Joint british diabetes societies inpatient care group.
The authors should be congratulated on their achievement. Diabetic ketoacidosis dka critical care guideline two. Diabetic ketoacidosis dka management algorithm adult. Acute management of diabetic ketoacidosis in adults this protocol is for the acute management of diabetic ketoacidosis in patients 16 years and over. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. According to the search for diabetes in youth study, over the past ten years bdc provided care to 3,222 of the 3,500 children who were diagnosed in colorado. Completing more than 20,000 ambulatory encounters per year, bdc is the largest outpatient. This guideline describes the management of patients who present to a wa country health service wachs south west sw hospital with diabetic ketoacidosis dka. Adult dka management these recommendations do not take into account individual patient situations, and do not substitute for clinical judgment. Table 1 outlines the diagnostic criteria for dka and hhs.
Diabetic ketoacidosis dka, though preventable, remains a frequent and life threatening complication of. Dka at diagnosis is more common in children protocol. Stanford hospital and clinics glycemic control of diabetes mellitus stanford coordinated care glycemic control of diabetes mellitus protocol stanford coordinated care page 1 purpose. Unc pediatric dka guidelines this is a general guideline and does not represent a professional care standard governing providers obligations to patients. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. Montefiore subcutaneous insulin dka protocol this is a subcutaneous subq insulin protocol that replaces insulin drip needs for mild to moderate dka. Dka at diagnosis is more common in children hospital teams for rapid introduction and for acceptance as the national guideline for managing dka. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis dka is a serious problem that can occur in people with diabetes if their body starts to run out of insulin.
The biochemical criteria for the diagnosis of diabetic ketoacidosis dka are. Diabetic ketoacidosis care guideline for emergency department american diabetes association. This document does not replace the need for the application of clinical judgement to each individual presentation. Memorial hospital welcomes new nurses with traditional pinning ceremony while the covid19 pandemic has caused many school graduations to be cancelled, the nursing staff at memorial hospital made sure to honor their graduating student nurses with a traditional ceremony on wednesday welcoming these new nurses to their profession. Clinical guideline childrens hospital of richmond at vcu. Criteria and overview pathophysiology of dka explanation of evidence ratings summary of version changes inclusion criteria dka is defined as need all 3 criteria.
Diabetic ketoacidosis symptoms, diagnosis and treatment. In the dkahhs management protocol, regular insulin administered by i. Their widespread introduction should significantly improve the care of people admitted with dka. Glucose levels will be evaluated by finger stick testing or blood testing 2. At seattle childrens, a clinical standard work csw pathway is a documented approach to the management and treatment of a particular population or clinical condition. However, as in any clinical situation, there may be factors which cannot be covered by a single set of guidelines. Those with severe dka have a much higher mortality and risk of complications. This ensuing hyperglycemia results in a combination of osmotic diuresis, electrolyte abnormalities and ketone productionacidosis that can lead to significant morbidity and mortality. It also allows for a faster response to pg changes.
Joint british diabetes societies inpatient care group the management of diabetic ketoacidosis in adults. Change in blood glucose trend insulin infusion titration. Children and adolescents with dka should be managed in a unit that has. Hyperglycemic crises in adult patients with diabetes. The aim is to improve quality of care through the standardization of management based on evidence in published medical literature andor expert opinion. Uhb 096 guidelines in adults within the university version no. To enhance collaborative patient care by referral of patients with a diagnosis of type 1 or type2 diabetes dm to be comanaged by the clinical pharmacist, pharmacy resident or rn following this. Diabetic ketoacidosis dka this document reflects what is currently regarded as safe practice. If protocol contraindicated or not ordered, notify physician. Page 1 of 7 hyperglycemic emergency management dkahhs1. Weve helped produce the management of diabetic ketoacidosis in adults, pdf, 4mb published by the joint british diabetes societies inpatient car. This is a quality improvement document and should not. Ispad clinical practice consensus guidelines 2014 compendium. Experienced nursing staff trained in monitoring and management of dka in children and adolescents.
One approach to delivering best clinical practices is development of inpatient standardized protocols for dka management. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Emergency nurses collaborate with interprofessional colleagues to develop, approve, and evaluate evidencebased protocols within the emergency nursing scope of practice to assure they are consistent with current best. Decrease rate of change of insulin infusion by 50% if blood glucose decreases by 100 mgdl per hour and notify physician. Prompt diagnosis and appropriate therapy are essential for a good outcome for these patients. Barbara davis center home university of colorado school. Diabetic ketoacidosis dka childrens hospital colorado. The dka medical protocol can also be downloaded in fillable pdf format 20200208version. Rashida woods, md pediatric critical care medicine owner. It is for nurses new to the unit, for nurses who have not cared for a patient with diabetic ketoacidosis for some time and for anyone who wishes to expand their knowledge of diabetic ketoacidosis. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Access to laboratory services for frequent and timely evaluation of biochemical variables.
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