DKA (Quick Summary) - Maryam Altayeb.pdf

Severe diabetic ketoacidosis can result in Kussmaul breathing (ie, deep, rapid breathing with associated increased thoracic and diaphragmatic activity).  It occurs as a respiratory compensation for severe metabolic acidosis.

Kussmaul Breathing seen in Diabetic Ketoacidosis (DKA) #mbbs #medicine #neetpg #aiims #usmle

Kussmaul Breathing in Diabetic Ketoacidosis (DKA)

Kussmaul Breathing in Diabetic Ketoacidosis

Kussmaul breathing in Diabetes ketoacidosis, Dept of medicine, sawangi

DKA Classification in Pediatrics

| DKA Severity | pH | HCO₃⁻ (mEq/L or mmol/L) | Clinical Features | | --- | --- | --- | --- | | Mild DKA | 7.2 – <7.3 | 10 – <15 | Alert, mild dehydration | | Moderate DKA | 7.1 – <7.2 | 5 – <10 | Drowsy, moderate dehydration, tachypnea | | Severe DKA | <7.1 | <5 | Altered mental status, Kussmaul breathing, dehydration, risk of cerebral edema |

Management of Diabetic Ketoacidosis by M. Agus | OPENPediatrics

Management of a Paediatric Patient with Diabetic Ketoacidosis

• The treatment of choice for diabetic ketoacidosis is intravenous normal saline and insulin.  These therapies increase serum bicarbonate and sodium levels, lower serum glucose and potassium levels, and decrease overall serum osmolarity.
  • ABCDE
  • Start intravenous fluid infusion 10 ml/kg of normal saline over 1 hour
  • Then after 1 hour start IV regular insulin as continuous infusion 0.1 IU per kg per hour and add KCl 40 meq per L once urine output is confirmed
  • If glucose decreases to 250 mg /dl then shift IV fluid to D5 half normal saline
  • The deficit of dehydration should be given over 48 hours
  • If glucose is below 250 mg/dl , blood gas is normal and patients s continuous then start SC insulin then after 30 minutes giv a meal then after 60 minutes stop the insulin
• best initial Tx in DKA: IV fluids (0.9% NS)
  • once started, monitor potassium in case it drops
    • hypokalemia with insulin infusion
• appropriate rate of serum glucose reduction in a patient with DKA: 3 mmol/L per hour
  • to prevent cerebral edema
  • doses of IV regular insulin usually decrease the serum glucose concentration by approximately 50 to 70 mg/dL (2.8 to 3.9 mol/L) per hour, do not allow the serum glucose at this time to fall below 200 mg/dL (11.1 mmol/L)
• Cerebral edema is the most common complication of DKA

General Principles (All DKA Stages):

• Initial labs: glucose, VBG, Na⁺, K⁺, Cl⁻, HCO₃⁻, BUN, Cr, Ca²⁺, Mg²⁺, phosphate, ketones, urinalysis
• Monitor: neuro status, vitals hourly, glucose & electrolytes q2–4h
• Start with fluids — insulin comes after volume resuscitation begins
• Avoid bicarbonate unless pH <6.9 with life-threatening instability

Mild DKA (pH 7.2–<7.3, HCO₃⁻ 10–<15):