Emergency treatment for ketoacidosis in diabetic patients

Post by Master, Doctor Phan Van Phong - Emergency Doctor - Emergency Department - Vinmec Central Park International General Hospital

The cause of diabetic ketoacidosis is usually due to discontinuation of insulin therapy or inadequate insulin therapy in type 1 diabetes, decompensation of newly discovered type 1 diabetes, or acute medical conditions. The treatment of ketoacidosis is often primarily about correcting water and electrolytes, resolving metabolic acidosis, correcting insulin deficiencies, and identifying and treating precipitating factors.

1. What is ketoacidosis in diabetics?

Diabetic ketoacidosis is characterized by the triad of hyperglycemia, metabolic acidosis with increased anion gap, and ketosis.

2. Causes of ketoacidosis in diabetic patients

Discontinuation of insulin therapy or inadequate insulin therapy in type 1 diabetes New onset of type 1 diabetes decompensation (20-25%) Acute conditions: + Infection (30-40%) : Pneumonia, urinary tract infection, gastrointestinal infection... + Cerebrovascular accident + Myocardial infarction + Acute pancreatitis Drugs (corticosteroids, clozapine, cocaine, lithium, terbutaline) Trauma.

3. Clinical and subclinical symptoms

Symptoms of diabetic ketoacidosis develop rapidly, usually within 24 hours. Clinical symptoms include:
Neurological symptoms: Not prominent Abdominal pain with nausea and vomiting, not specific. Hyperventilation: Kussmal breathing pattern, breath smell of ketones Acute tachycardia, decreased CO > hypotension. Subclinical:
Blood glucose- HbA1C Electrolyte- anion gap Blood gas Ketone blood- total urinalysis for ketones

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4. First aid for ketoacidosis

First aid for ketoacidosis includes the following steps:
Adjust water and electrolytes, dialysis pressure, circulating volume, blood sodium, blood potassium Resolve metabolic acidosis Replenish insulin deficiency Identify and treat precipitating factors. Drugs: Insulin 0.1 units/kg/hour, increase rate if blood glucose falls below 10% on previous test or acidosis has not improved. High-corrected sodium isotonic infusion: Use 0.45% sodium chloride, low-corrected sodium use 0.9% sodium chloride. Bicarbonate is recommended when blood pH < 6.9.

5. Follow-up after treatment

Patients should be monitored for vital signs every 30 minutes for the first hour, every 1 hour for the next 4 hours, and every 2-4 hours until the ketoacidosis is completely resolved. Blood sugar per hour: Target 200-300mg/dl Electrocardiogram monitoring (QRS time, T vital morphology) In addition, electrolytes, kidney function, blood gases, blood ketone levels and blood glucose levels should also be monitored. Urine, increased blood osmolality was also monitored every 4 hours until the patient was completely stable. In summary, diabetic ketoacidosis is characterized by a triad of hyperglycemia, metabolic acidosis with increased anion gap, and ketosis. The first aid for ketoacidosis is often primarily about correcting water and electrolytes, resolving metabolic acidosis, correcting insulin deficiency, and identifying and treating precipitating factors.

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