Various guidelines are described for potassium replacement 12. Common symptoms and signs include polyuria, polydipsia, polyphagia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, i. Management of diabetic ketoacidosis in pregnancy dkp figure 1 dkp is considered as an emergency that needs to be managed in at least level 2 critical care units, 5 such as a. Although dka in pregnancy is uncommon incidence of 1% to 9% in pregnancies already complicated by diabetes, clinicians must be ready to initiate aggressive therapy.
Both diabetic ketoacidosis and hhs result from relative or. A high index of suspicion is required, because diabetic ketoacidosis onset in pregnancy can be insidious, usually at lower glucose levels, and often progresses more rapidly as compared with nonpregnancy. Pregnancies complicated by diabetic ketoacidosis are associated with increased rates of perinatal morbidity and mortality. Remember, in addition to the usual symptoms and signs of dka, pregnant women can also present. The 2009 american diabetes association ada position. Diabetic ketoacidosis in pregnancy ahmed walid anwar morad. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic ketoacidosis in pregnancy dkp is a serious. Diabetic ketoacidosis in pregnancy pubmed central pmc. Near patient testing for the ketones is now readily available for monitoring allowing for a shift away from using glucose levels to drive treatment decisions in the management of dka. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7.
Diabetic ketoacidosis in pregnancy postgraduate medical. Management of diabetic ketoacidosis in pregnancy dkp figure 1 dkp is considered as an emergency that needs to be managed in at least level 2 critical care units, 5 such as a high. Common symptoms and signs include polyuria, polydipsia. The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother. Fortunately, the occurrence of dka in women with diabetes who become. Key content diabetic ketoacidosis in pregnancy dkp is a serious. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes.
Guidelines for the management of patients with dka and hhs in. Target audience this educational activity has been designed to meet the. Review diabetic ketoacidosis in pregnancy d kamalakannan, v baskar, d m barton,tamabdu postgrad med j 2003. Diabetic ketoacidosis dka in pregnancy is associated with high fetal mortality rates.
It tends to occur latter in pregnancy and is more common in patients with. Guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. Diabetic ketoacidosis in pregnancy is an emergency that demands prompt and vigorous treatment in a high dependency unit under combined. Mar 15, 2017 management of diabetic ketoacidosis in pregnancy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Fortunately, the occurrence of dka in women with diabetes who become pregnant is rare %.
Diabetic ketoacidosis may be diagnosed when the combination of hyperglycemia high blood sugars, ketones in the blood or on urinalysis and acidosis are demonstrated. Dilated eye examinations should occur ideally before pregnancy or in the. A concerning number of people also develop dka while already in hospital. The roles of bicarbonate, phosphorous, magnesium, insulin, potassium, and fluids are discussed along with conditions such as pregnancy, infection, pancreatitis, and abdominal pain, which. Guidelines for management of diabetic ketoacidosis. Diabetic ketoacidosis dka critical care guideline two. Treatment of the patient with diabetic ketoacidosis includes insulin therapy and careful. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes primarily potassium. A small percentage of dka occurs in the absence of high glucose levels seen in traditional dka. The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management of diabetic ketoacidosis dka and hyperosmolar hyperglycaemia state.
Glm0061238890 diabetic ketoacidosis dka management in. Diabetic ketoacidosis dka critical care guideline two bag system inclusion criteria definition of dka. Management of glycaemic control in pregnant women with. The entity of euglycemic diabetic ketoacidosis is not limited to patients using sglt2 inhibitors, however, as it has also been described in the setting of alcohol use disorders, pregnancy, and chronic liver disease. Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Diabetic ketoacidosis and pregnancy american board of.
Diabetic ketoacidosis dka is a serious condition that can lead to diabetic coma passing out for a long time or even death. In the absence of prompt diagnosis and treatment dka can be life. Guidelines and position statements from medical the care of their patients. The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management of diabetic. Management of diabetic ketoacidosis in pregnancy mohan. Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus.
All users must refer to the latest version from the including photocopies, may not reflect the latest version. Diabetic ketoacidosis in pregnancy obstetric intensive care. Treatment of the patient with diabetic ketoacidosis includes in sulin therapy and careful fluid. Despite intensified insulin treatment and strict surveillance of metabolic control in diabetic women during pregnancy, diabetic ketoacidosis dka complicates 29% of diabetic pregnancies 1. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type. Diabetic ketoacidosis is characterised by a biochemical triad of hyperglycaemia, ketonaemia, and acidaemia, with rapid symptom onset. Diabetes mellitus management of preexisting diabetes. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
Management of diabetic ketoacidosis in adults clinical guideline v4. Diabetic ketoacidosis guidelines bmj best practice. Management of diabetic ketoacidosis in adults age 16. Diabetic ketoacidosis in pregnancy is a rare but potential lifethreatening condition for the mother and the fetus.
Management of diabetic ketoacidosis in pregnancy obstetrics and. The entity of euglycemic diabetic ketoacidosis is not limited to patients using sglt2 inhibitors, however, as it has also been described in the setting of alcohol use disorders, pregnancy, and chronic liver. Joint british diabetes societies inpatient care group. Although type 1 pregnancy ketoacidosis is most common, patients with type 2 or gestational diabetes should be monitored for dka throughout. Mar 31, 2017 guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic. This article outlines updates in the clinical management of. Updates in the management of diabetic ketoacidosis the. Diabetic ketoacidosis in pregnancy semantic scholar. Diabetic ketoacidosis dka is not a rare presentation to hospital, despite being an entirely preventable condition. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009.
Sep 20, 2010 although dka in pregnancy is uncommon incidence of 1% to 9% in pregnancies already complicated by diabetes, clinicians must be ready to initiate aggressive therapy. Any printed versions, this document is to be viewed via the cdhb intranet only. Chglm0061 238890 diabetic ketoacidosis dka management in pregnancy cdhb intranet at all times. New guidelines recently launched, combination of sign and nice. In about 10% of cases the blood sugar is not significantly elevated euglycemic diabetic ketoacidosis. Management of adult diabetic ketoacidosis this article was published in the following dove press journal.
A 35yearold nulliparous diabetic, usually wellmanaged with a subcutaneous. Introduction hhs and dka are not mutually exclusive but rather two conditions that both result from some degree. Immediate management acute management of diabetic ketoacidosis in adults this protocol is for the acute management of diabetic ketoacidosis in patients 16 years and over. When your cells dont get the glucose they need for energy, your body begins to. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Managing severe preeclampsia and diabetic ketoacidosis in. Management of diabetic ketoacidosis in adults clinical. In the last decade, however, there has been a change in the way patients with dka present clinically and in addition there has been rapid development of nearpatient testing. Guidelines for the management of patients with dka and hhs. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%.
An understanding of these physiologic changes assists in the management of the two patients being treated. Pdf management of diabetic ketoacidosis in pregnancy. Pregnancy is a ketogenic state, and women with type 1 diabetes, and to a lesser extent those with type 2 diabetes, are at risk for diabetic ketoacidosis at lower blood glucose levels than in the nonpregnant state. Glm0061238890 diabetic ketoacidosis dka management. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination. Joint british diabetes societies inpatient care group the management of diabetic ketoacidosis in adults second edition update. Diabetic ketoacidosis symptoms, diagnosis and treatment. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. Jan 24, 2017 management of diabetic ketoacidosis in pregnancy dkp figure 1 dkp is considered as an emergency that needs to be managed in at least level 2 critical care units, 5 such as a high. More importantly, recognition and prevention of diabetic ketoacidosis risk factors in populations in whom these thresholds are lowered ie, hispanics, nonhispanic blacks, and pacific islanders, for whom the american college of obstetricians and.
Management of dka has changed in the last decade, and national guidelines introduced, to help standardise care, spread best practice, and reduce mortality and morbidity. Management of diabetic ketoacidosis in adults age 16 years. If you continue browsing the site, you agree to the use of cookies on this website. September 20 this document has been endorsed by the intensive care society. Miscarriage, preeclampsia and preterm labour are more common in women with preexisting diabetes. When your cells dont get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Dka onset and recurrence can largely be prevented through patient education. Pdf diabetic ketoacidosis in pregnancy dkp is a serious complication that poses several challenges with respect to diagnosis. Diabetic ketoacidosis dka is the metabolic abnormality of type 1 diabetes. Pregnancy complicated by diabetic ketoacidosis diabetes care. Joint british diabetes societies inpatient care group guidelines4 state the. Nurse practitioners are well positioned to promote patient education, self management, and individualized patient care. More importantly, recognition and prevention of diabetic ketoacidosis risk factors in populations in whom these thresholds are lowered ie, hispanics.
If a patient has elevated bgl and ketones but is not acidotic they need to be closely monitored and agressively managed to prevent progression to dka. Diabetic ketoacidosis in pregnancy dkp is a serious complication that poses several challenges with respect to diagnosis, management and prevention. Management of diabetic ketoacidosis in pregnancy mohan 2017. Management of diabetic ketoacidosis in pregnancy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Diabetic ketoacidosis in pregnancy postgraduate medical journal. Maternal and fetal outcomes despite intensified insulin treatment and strict surveillance of metabolic control in diabetic women during pregnancy, diabetic ketoacidosis dka complicates 29% of diabetic pregnancies and represents the leading cause of fetal loss, with a fetal mortality rate of 3090%. Management of diabetic ketoacidosis and hyperosmolar. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Dilated eye examinations should occur ideally before. Diabetic ketoacidosis affects only 1% to 3% of pregnancies complicated by diabetes. Specific issues in relation to diabetic ketoacidosis in pregnancy please also see jbds dka guidelines additional jbds guidelines may be helpful in certain situations. Near patient testing for the ketones is now readily available for monitoring allowing for a shift away from using. Diabetic ketoacidosis dka is a serious complication of diabetes often resulting in a medical emergency. Despite recent advances in the evaluation and medical treatment of diabetes in pregnancy, diabetic ketoacidosis dka remains a matter of significant concern.