Is there a diabetic ketoacidosis guideline? Diabetic ketoacidosis (DKA) is a serious complication of diabetes. It occurs when your body produces too little insulin. When there is not enough insulin, and sugar is not reaching your cells, the human body begins to break down fat as an alternative fuel. This causes toxic acids to enter the bloodstream, these are called ketones. Ketoacidosis may cause nausea, vomiting, shortness of breath, and even death.
In 1995 Consensus Guidelines were created by the International Society for Pediatric and Adolescent Diabetes (ISPAD). They are still considered the most accepted diabetic ketoacidosis guidelines. This is because these guidelines are believed to be the safest available in light of current evidence. It is recommended that any centers treating this condition should have a Diabetic Ketoacidosis Guideline immediately available.
According to this diabetic Ketoacidosis guideline, the severity of dehydration should be the first to be assessed in an emergency situation. This may be difficult it cases of young children, so the severity of dehydration is often overestimated. Doctors should also assess the person’s consciousness and look for any evidence of acidosis. If a child under 5 has a case with severe hyperventilation, shock, loss of consciousness, and persistent vomiting, it is recommended that the child be sent to the intensive care unit.
In case of shock with poor peripheral pulses, or in cases of coma, an Oxygen 100% face mask should be used to help in resuscitation. Normal saline should be given over a 10-30 minute period, and nasogastric tube should be administered if there is any loss of conscious or vomiting.
Diabetic Ketoacidosis Guideline
After being resuscitated, a period of clinical observations and monitoring should follow. According to the ISPAD Diabetic Ketoacidosis Guideline, pulse rate, respiratory rate and blood pressure should be checked hourly. Fluid input and output should be accurate and urine should be tested for glucose and ketones. Neurological observations should be checked hourly as well if not more frequently and ECG monitoring should also be practiced.
Treatment should continue with efforts of rehydration and insulin management. Children should be rehydrated more slowly than other patients would. In severe dehydration and acidosis the diabetic ketoacidosis guidelines only allow sips of cold water or ice to suck. Other oral fluids should only be given after substantial improvement with no vomiting. After being resuscitated potassium may need to be replaced, but it should not be administered unless the ECG monitoring tests normal. Insulin should not be started until after the potassium regimen has begun.
