Diabetic Ketoacidosis
Age: years old
Gender:
HISTORY:
Presents with a - history of
Blood glucose level:
Recent HbA1c level: %
Associated symptoms: *Try using right-click for negatives*
, , , ,
, episodes , ,
, , , ,
Contributing factors:
no history of: ,
no use of: , , ,
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Neck: , , , c-spine
Heart: , ,
Lungs: , ,
Abdomen: , , , , bowel sounds , ,
Skin: on
Extremities: , , cap refill sec, pulses , ,
Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait
Mental status: , , speech , mood , thought , , judgment
ASSESSMENT:
,
DDx: diabetic ketoacidosis, type 1 diabetes mellitus, type 2 diabetes mellitus, drug-induced diabetes, pancreatic disease-related diabetes, starvation ketosis, alcoholic ketoacidosis, lactic acidosis, uremic acidosis, thyrotoxicosis, adrenal insufficiency, sepsis, acute pancreatitis, ischemic bowel, cerebral edema, pulmonary edema, myocardial infarction, stroke, infection, non-compliance with insulin therapy, insulin pump failure, extreme stress, substance abuse
PLAN:
Investigations:
- Blood work: , , , , ,
- Urinalysis
- ECG
- Chest X-ray
Treatments:
- Follow protocol
- Normal saline 1L bolus, then 500cc/h x2h, then 250cc/h x4h
- KC 20 meq/L at 150cc/h if K less than 5.5 (must have urine output)
- 0.1 units/kg/h (stop when pH normalized)
- Bicarbonate infusion if pH < 7.0-7.1
- Urine output monitoring
Further care:
- Referral to ER
- Monitor glucose level every 1 hour
- Monitor electrolytes and blood gas every 2 hours
- Monitor vital signs every 15 minutes
- Admission to intensive care unit
- Referral to endocrinologist
- Follow-up in
HISTORY: Associated symptoms: EXAM: ASSESSMENT: PLAN: