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DIABETES MELLITUS-KETOACIDOSIS INX & MGM

Endocrinology

DIABETES MELLITUS-KETOACIDOSIS INX & MGM

1. Findings - metabolic acidosis, hyperglycemia, hypokalemia, hypophosphatemia, pseudohyponatremia.

2. Pseudohyponatremia - serum Na + is usually decreased because of the osmotic shift of water from inside cells to the intravascular space caused by the hyperglycemia.

3. Start IV insulin at 0.1 units/kg/hr. Keep the IV insulin going until the acidosis is resolved and anion gap is normal.

4. K + is shifted into the cells by both the reversal of acidosis and the action of insulin, further aggravating the hypokalemia and possibly leading to cardiac arrest.

5. Monitor the heart-wave morphology and rhythm for any K + -associated changes.

6. Bicarbonate is given only for pH < 7 .0, especially if the patient is having respiratory or hemodynamic collapse.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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