sulin leads to intracellular shifts in potassium. Patients with DKA ca

 

Fluid resuscitation clears ketones and other by-products o newsvilla.org f DKA. It also restores normal IV FLUIDS

blood and corrects electrolyte imbalances [6]. The patient’s serum sodium lev onnp.org els need to be checked to determine which type of fluid they need.

INSULIN

Insulin is the mainstay therapy for DKA. It promotes cellular utilization of glucose, which immediately decreases blood keto panifol.com ne and glucose concentrations.

Before giving insulin to DKA patients, however, you need to check the patient’s potassium levels because insulin leads to intracellular shifts in potassium. Patients with DKA can have normal or elevated blood potassium even with decreased potassium stores. This is a result of osmotic diuresis and transcellular fluid shifts.

If blood potassium levels are less than 3.3 mEq/L, you need to replete potassium before giving insulin therapy.

The rate of insulin therapy will depend on patient age, the presence of insulin sensitivity, and the severity of DKA.  

When blood glucose concentrations fall below 250mg/dl, adding 5% dextrose will prevent hypoglycemia. This will help continue insulin therapy until acidosis is resolved. Use up to 20% dextrose concentration if you are unable to prevent hypoglycemia.

ELECTROLYTES                           

Besides correcting potassium imbalances, you may need to ensure the patient’s blood magnesium concentration is over 2 mg/dl. Magnesium is a cofactor in cellular potassium uptake, and low levels can lead to refractory hypokalemia [7].

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