Management of Diabetic Ketoacidosis

Abstract

Diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus (DM), occurs more commonly in children with type 1 DM than type 2 DM. Hyperglycemia, metabolic acidosis, ketonemia, dehydration and various electrolyte abnormalities result from a relative or absolute deficiency of insulin with or without an excess of counter-regulatory hormones. Management requires careful replacement of fluid and electrolyte deficits, intravenous administration of insulin, and close monitoring of clinical and biochemical parameters directed towards timely detection of complications, including hypokalemia, hypoglycemia and cerebral edema. Cerebral edema may be life threatening and is managed with fluid restriction, administration of mannitol and ventilatory support as required. Factors precipitating the episode of DKA should be identified and rectified. Following resolution of ketoacidosis, intravenous insulin is transitioned to subcutaneous route, titrating dose to achieve normoglycemia.

The Impact of Hyperglycemic Emergencies on the Kidney and Liver

“…Upon presentation of the symptoms, the magnitude of specific deficits in an individual patient varies, depending on the duration and severity of T1D or DKA [ 13 , 21 ]. The success of treatment is significantly associated with the correct management of hyperglycemia reduction, metabolic acidosis rectification, and electrolyte deficit replacement [ 21 ]. Acute hyperglycemia causes vasodilation and alters endothelial function in adolescents with T1D [ 22 ].…”

Diabetic ketoacidosis complicated by generalized venous thrombosis

“…It is characterized by hyperglycemia, ketonemia, metabolic acidosis and a variety of metabolic derangements, generally resulting from a relative or absolute deficiency of insulin with or without counter-regulatory hormone release [2]. Vessel wall injury, stasis and hypercoagulability form the Virchow's triad for predisposition to thrombosis.…”

Penanganan Ketoasidosis Diabetik pada Anak

“…Prinsip tata laksana KAD meliputi terapi cairan untuk koreksi dehidrasi dan menstabilkan fungsi sirkulasi, pemberian insulin untuk menghentikan produksi badan keton yang berlebihan, mengatasi asidosis dan gangguan keseimbangan elektrolit, mengatasi faktor presipitasi atau penyakit yang mendasari KAD, serta monitor komplikasi terapi. 3,9 Tata Laksana Awal Penanganan awal pasien KAD pada anak harus sesuai penanganan umum pasien gawat darurat sesuai pedoman Pediatric Advanced Life Support (PALS) meliputi stabilisasi airway, breathing, circulation: 11,12 Airway: amankan jalan napas. Jika perlu kosongkan isi lambung pada pasien dengan penurunan kesadaran Breathing: berikan oksigen pada pasien dengan dehidrasi berat atau syok Circulation: pemantauan jantung sebaiknya menggunakan EKG untuk evaluasi kemungkinan hiperkalemia atau hipokalemia.…”