Why is there Hypophosphatemia in DKA?
Hypophosphatemia may be worsened during treatment of DKA because insulin causes a shift of phosphate into the cellular compartment and fluid replacement dilutes the phosphate concentration [1]. These factors frequently lead to mild to moderate hypophosphatemia in DKA patients.
Why is metformin contraindicated in ketoacidosis?
Diabetic ketoacidosis may be tricky to diagnose in the context of metformin: Metformin itself may promote the catabolism of fats and production of ketoacid. Metformin may cause hypoglycemia (so the patient may not have features of classic diabetic ketoacidosis).
How does DKA cause hypovolemia?
As an excessive amount of glucose enters the renal tubules, it draws a large amount of water that ends up producing a significant amount of urine. This is known as osmotic diuresis and leads to volume depletion and dehydration in the patient.
What are the 3 diagnostic criteria for DKA?
DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.
How does DKA cause hyperphosphatemia?
It is concluded that hyperphosphatemia is common in diabetic ketoacidosis before therapy. The increase in serum phosphorus is likely to be due to a transcellular shift. Potential factors responsible for the shift are serum glucose, through its osmotic effect, and the organic anions.
When do you give phosphate in DKA?
Encephalopathy, confusion, seizures, hallucinations, and coma are the clinical signs that may develop during prolonged, severe hypophosphatemia following treatment of DKA. When verified, these symptoms should be promptly treated with intravenous phosphate, which often result in dramatic recovery.
Does metformin help with DKA?
(HealthDay News) — For patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia, metformin and sitagliptin treatment after normoglycemia remission correlate with increased relapse-free survival and prolonged remission, according to a study published online in Diabetes Care.
When should I restart metformin after DKA?
Current guidelines recommend stopping metformin use before imaging procedures that use contrast, and restarting use 48 hours after the procedure if renal function is unchanged.
How is hypovolemia corrected in DKA?
Rapid reversal of shock and slow rehydration. Hypovolemia shock with hypotension should be treated by rapid restoration of intravascular volume using isotonic crystalloid solutions such as 0.9% saline. In the first two hours 1-2 L of fluid may be required to correct hypovolemia.
Is DKA hypovolemic shock?
Hypovolemic shock is a rare occurrence in DKA, and should prompt evaluation for other causes, such as sepsis. Following initial fluid resuscitation, replace the estimated fluid deficit over 24 to 48 hours, in addition to maintenance fluids.
What level of ketones is DKA?
The meter is considered to be accurate up to a ketone concentration of 3.0 mmol/l, which is the threshold for the diagnosis of DKA.
What happens in hyperphosphatemia?
When you have hyperphosphatemia, the phosphate levels in your body become very high. Your kidneys are supposed to excrete 90% of your daily phosphate load. Your gastrointestinal tract excretes the remaining phosphate. When you have kidney problems, your phosphate levels can’t be regulated.
What is a DKA protocol?
One protocol entails using insulin and intravenous fluids until the serum potassium concentration is less than 5.5 mEq per L (5.5 mmol per L). At this time, potassium chloride is added to intravenous fluids in the amount of 20 to 40 mEq per L.
What should you administer in DKA?
Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you’ll receive insulin therapy — usually through a vein.
How does metformin treat lactic acidosis?
The management of metformin-associated lactic acidosis (MALA) is controversial. Treatment may include supportive care, activated charcoal, bicarbonate infusion, hemodialysis, or continuous venovenous hemofiltration.
Can you give insulin and metformin together?
CONCLUSIONS—In type 2 diabetic patients who are intensively treated with insulin, the combination of insulin and metformin results in superior glycemic control compared with insulin therapy alone, while insulin requirements and weight gain are less.
How many points does metformin lower blood sugar?
With metformin, your A1C (Glycated hemoglobin) can be reduced between 1 and 1.8 points, says Albanese. And you may even lose a little weight. How much is a little?
When do you stop fluids in DKA?
Fluid therapy Fluid loss averages approximately 6–9 L in DKA. The goal is to replace the total volume loss within 24–36 hours with 50% of resuscitation fluid being administered during the first 8–12 hours.
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