Diabetic ketoacidosis is a serious and life threatening complication of diabetes. It occurs when the body is not able to use glucose for energy (due to lack of insulin) and starts using fat instead. Use of fat leads to the formation of a fat breakdown product called ketones. Rise of blood ketones to high levels causes diabetic ketoacidosis. If the condition is not treated in time, it can be fatal. A person with diabetic ketoacidosis is usually admitted in the hospital and treated in the emergency room or intensive care unit. Fluid replacement and insulin administration intravenously (IV) is very important in the initial treatment of diabetic ketoacidosis. These therapies work to correct dehydration, lower blood acid levels, correct elevated blood sugar to normal levels and restore electrolyte balance.
Fluid replacement: The patient is given fluids either orally or through a vein (intravenously) until the fluid deficit (dehydration) is corrected. The aim of fluid replacement is to replace the fluids lost through excessive urination and dilute the excess of sugar in blood. Fluids are administered slowly; if they are given at an excessive rate or more than required, they can cause swelling of the brain (cerebral edema). Most people are given potassium with IV fluids to correct the depletion of this important electrolyte in the body in diabetic ketoacidosis.
Electrolyte replacement: Electrolytes are minerals present in the blood that carry an electric charge. Some important electrolytes present in the blood include sodium, potassium and chloride. Lack of insulin and loss of fluid through vomiting can lower the level of several electrolytes in the blood. Electrolytes help to keep the heart, muscles and nerve cells function normally. When the fluid is replaced, electrolytes are also given through the veins. The doctor adds electrolytes to the fluid as needed.
Insulin therapy: Diabetic ketoacidosis is caused due to insulin deficiency and insulin therapy reverses the processes of diabetic ketoacidosis. Insulin therapy is started promptly without any delay. It is usually given as a continuous infusion and not as a bolus injection in the vein. It is given through a vein along with fluids and electrolytes.Insulin replacement by way of fluid replacement is done slowly. The aim of insulin therapy is to stop further ketone formation and to stabilise tissue function by allowing the cells to use glucose in the blood for fuel and drive available potassium back into the body's cells. Once blood glucose levels have fallen below 240 mg/dL(13.3 mmol/L) and the blood ketone levels is also low, intravenous insulin therapy is usually stopped and a regular insulin therapy is started.
Besides correction of fluid loss, electrolyte imbalance and insulin therapy, the cause that triggered the episode of diabetic ketoacidosis is also treated. For instance, if bacterial infection is suspected, the doctor may prescribe antibiotics.
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