糖尿病酮酸中毒 Diabetic Ketoacidosis (DKA)

Mechanism 致病機制
Criteria 診斷標準
1. Blood glucose > 250mg/dl
2. plasma [HCO3] < 18nEq/L
3. plasma pH <= 7.30
4. Elevated anion gap
5. Evidence of ketones in blood or urine
ps. there are exceptions
according to 美國糖尿病學會 American Diabetes Association

Management 處理流程
1. Intravenous Fluids 輸液
- Start with Isotonic saline 1L/hr (15-20ml/hr), decrease rate to 250-500ml/hr when BP normalizes
- When blood glucose falls to 250mg/dL, change to 5% dextrose in 0.45% saline and infuse at 250-500ml/hr
2. Insulin 給胰島素
- Regular insulin (RI): 0.15 U/kg as IV bolus, then infuse at 0.1U/kg/hr
- Adjust infusion so that blood glucose decreases by 50-75mg/dL/hr
- When blood glucose < 250 mg/dL, decrease to 0.1-0.5 U/kg/hr, maintain blood glucose at 150-200mg/dL
- Begin SC (Subcutaneous) insulin when pH > 7.3 and oral fluids are tolerated, continue IV insulin for a few hours after starting SC insulin
3. Potassium 補鉀
- [K+] < 3.3 mEq/L initially, hold insulin infusion, and give 40mEq/L/hr potassium until [K+] >= 3.3mEq/L
- 3.3 < [K+] < 4.9 mEq/L initially, give 20-30 mEq/L in IV fluids to keep [K+] at 4-5 mEq/L
- [K+] >= 5 mEq/L initially, do not give K+, check serum [K+] every 2 hours

Memo 注意事項

Reference: 1. The ICU book, 4th Edition, Paul L. Marino