Treatment of DKA
Posted on November 12, 2009
Filed Under Ketoacidosis | Leave a Comment
Diabetic ketoacidosis (hereinafter referred to DKA) is the acute complications of diabetes is also common acute medical one.
DKA is due to absolute or relative lack of insulin and insulin antagonist hormones increase, resulting in strong gluconeogenesis, glycogen output increased, blood sugar is too high, and also because fat mobilization and decomposition accelerates the formation of ketone bodies increase and the use of slow, so a lot of blood ketone accumulation occurred ketoacidosis. Therefore, the treatment is to give the first of exogenous insulin, the rapid reversal of in vivo metabolism disorders. It was reported that intravenous insulin-speed 4 ~ 10u / h, can remain stable blood insulin in 100 ~ 200mu / L, this concentration can maximally inhibit the decomposition of body fat, thereby inhibiting formation of ketone bodies, inhibit gluconeogenesis, and ketone bodies and organizations to improve peripheral glucose utilization. Thereby accelerating the correction of ketoacidosis. And the low-dose continuous infusion of insulin, has achieved rapid and effective therapeutic concentration, plasma insulin levels stable and overcome the shortcomings of the short half-life of insulin injections, but also has easy-to-predict blood glucose concentration and insulin concentration in the advantages of ease of adjustment. The amount of insulin chosen meet the above requirements, it avoids the concentration of effective treatment for subcutaneous injection of insulin to slow, easy-to-accumulation and previous high-dose application of insulin caused by hypokalemia, hypoglycemia, cerebral edema phenomenon, therefore, low-dose insulin is the treatment of diabetic ketoacidosis safe, secure and reliable and effective measures.
As a short half-life of intravenous insulin, and the incentives are not removed, the high recurrence rate of diabetic ketoacidosis, blood glucose rise large. Thus, DKA rescue of insulin adequate, timely subcutaneous injection, you can effectively prevent repeated ketoacidosis. We use to stop continuous infusion of insulin before, according to blood sugar, urine sugar situation, subcutaneous injection of insulin 8 ~ 16 units of quick, non-recurrence of ketoacidosis rare.
Rehydration is the key to ketoacidosis during the treatment. Patients with a large number of sugar, ketones and its metabolites from the urine to form osmotic diuresis, while patients with nausea, vomiting and other gastrointestinal tract symptoms to decrease water intake, can cause severe dehydration. Dehydrated state, insulin can not fully play its role, therefore, is quick to add liquid, to correct dehydration, is another important factor in successful treatment. We use intravenous rehydration and gastrointestinal dual approach can quickly correct the dehydration, but also to avoid the dangers caused by improper rehydration.
Strictly control the application of basic drugs. Because the basic drug treatment often leads to low serum potassium, abnormal cerebrospinal fluid PH value is reduced, excessive sodium load, the reaction alkalosis, as well as inhibiting the dissociation of hemoglobin with oxygen, which leads to tissue hypoxia even lead to cerebral edema. Our approach is that only carbon dioxide, together less than 10mmol / L and only when given 5% sodium bicarbonate treatment, the average input volume (100 ± 40) ml, avoid high-sodium, low potassium, cerebral edema, oxygen from the curve to the left occurred.
DKA is one of serious complications for the treatment of hypokalemia. Because a large number of rehydration, the use of insulin and acidosis after complete remission, prone to cause hypokalemia.
Comments
Leave a Reply