Literature Review of Diabetic Ketoacidosis

This literature review discusses the treatment protocols for diabetic ketoacidosis (DKA), a life-threatening emergency condition that occurs in both type 1 and type 2 diabetes. The review evaluates two articles that describe the treatment of DKA, including fluid resuscitation, insulin therapy, electrolyte management, and education. The main objective is to develop evidence-based treatment guidelines for DKA, which involves correcting intervascular, intercellular, and interstitial volumes, as well as managing potassium levels. The review also highlights the importance of patient education in managing insulin levels during hospital stay.

LITERATURE REVIEW 1
LITERATURE REVIEW
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LITERATURE REVIEW 2
LITERATURE REVIEW
Diabetic Ketoacidosis (DKA) is a life-threatening emergency condition; the main symptoms
are insulin deficiency and high levels of sugar in the body. Diabetic ketoacidosis is most
common in type 1 Diabetes but it is also found in type 2 diabetes. In this paper, we will
evaluate two articles that discuss DKA treatment protocols. (American Diabetes Association
(2004).
George S. And Dolores of University of Utah has described the treatment of diabetic
ketoacidosis in the emergency .As we know that untreated Diabetes causes DKA which is the
most severe complication. It is life threatening in nature hence serious and effective measures
are required. In this ,treatment with varying amount of fluid replacement and insulin is done.
The main objective of the project is to identify and develop evidence based treatment
guideline for DKA. The diagnosis of DKA is by serum bicarbonate level <18mEq/L , pH<
7.3, ketonemia and ketonuria , an anion gap > 10, and blood glucose >250. Here the key of
treatment is fluid resuscitation. Intervascular , intercellular and interstitial volumes are
corrected . Different authors have different approaches in this. (Arora et al 2011)Electrolyte
management is also the fundamental part of DKA. The most followed practise is insulin drip
which has been followed and accepted by almost everyone with few variations.
Dr R D Hardern , Department of Accident and Emergency Medicine , The general Infirmary ,
Great George street has carried out on Medline and the Cochrane Databases using DKA. The
treatment includes four things. Fluid, Insulin, potassium and Education. A catheter is installed
in patients who are hemodynamically unstable and required measurement of urinary output.

LITERATURE REVIEW 3
Hydration is the main process followed in this. Good venous access is required and blood
samples have to be sent off quickly. The nasogastric tube should be put in place if the patient
is not conscious. In this 0.9% saline 500 ml/ h for four hours then 250 ml/h until euvolemic
is in the effective fluid regime.( Singh RK et al 1997) This should be followed unless the
patient is shocked. Insulin has to be administered constantly through intravenous way at 0.1
unit /kg/h. It has to be monitored that the fall of glucose should not be more than 5mM/h.
Potassium supplementation has to be started once insulin treatment is done. As per the author
the administration of bicarbonate does not increase recovery. Another very important aspect
which is not considered by other authors is Education . (Kitabchi AE 1995)Patient needs to
be taught that how can he manage his insulin levels during his stay away from the hospital.
With this treatment, good prognosis has been noticed with mortality 3.9% . No discussion on
derangements in intermediary metabolism is involved in the article.
Continuous subcutaneous use of insulin is followed by both authors and have been found to
be effective. As technology has improved, the risk has fallen and patients are having a better
prognosis. The current approaches do not differ much as far as the administration of insulin is
considered. Rest there are many new ways of treating DKA.

LITERATURE REVIEW 4
References
American Diabetes Association (2004). “Hyperglycemic crises in diabetes.” Diabetes Care,
27(1), 94-102.
Arora, S., Henderson, O., Long, T., & Menchine, M. (2011). “Diagnostic accuracy of point-
of-care testing for diabetic ketoacidosis at emergency-department triage.” Diabetes Care,
34(4), 852-854..
Singh RK, Perros P, Frier BM. Hospital management of diabetic ketoacidosis: are clinical
guidelines implemented effectively? Diabet Med1997;14:482–6.
Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am1995;79:9–37