rate for low risk DKA, the authors selected return to an Emergency Room (ER) within Oxygen saturation was 78% on ambient air. She did not receive bicarbonate as her blood pH was not lower than 6.9 (Our 45-year-old male patient in Case 2 remained hemodynamically and neurologically stable with good oxygenation by face mask. Early reports indicate that among patients with pre-existing diabetes, DKA may be a common complication of severe COVID-19 and a poor prognostic sign.This clinical perspective explores the key elements of caring for individuals with DKA during the COVID-19 pandemic through 2 cases. and nursing concerns about prolonged ER stays and potential inadequate resolution Since clearly This QI project was initiated in April 2016, and compared a pre-period (January 1, Since clearly factors beyond the child’s laboratory values must go into clinical decision making, the authors added the following key factors to “mild DKA” to further define “low risk DKA”: established diagnosis of T1DM, good knowledge of sick day management and ability to do home care, and no concerning social conditions or comorbidities that would impede discharge.

Choose one of the access methods below or take a look at our If you have a Best Practice personal account, your own subscription or have registered for a free trial, log in here:If your hospital, university, trust or other institution provides access to BMJ Best Practice through services such as OpenAthens or Shibboleth, log in via this button:If you have been provided an access code, you can register it here:For any urgent enquiries please contact our customer services team who are ready to help with any problems.The entered sign-in details are incorrect. %PDF-1.6 %���� “Mild DKA” was previously defined in the International Severe dehydration Mild dehydration Cardiogenic shock Adminster NaCl …

to do home care, and no concerning social conditions or comorbidities that would impede Although substantive data on insulin requirements during COVID-19 are not yet published, clinicians have observed higher than usual insulin needs (up to 4 units/kg/day) in critically ill patients with COVID-19 (As noted previously, the resolution of DKA is heralded by a rapid increase in insulin sensitivity, which is more dramatic in severe DKA. Our aim was to reduce hospitalization rates for children with established T1D presenting to our ED with mild DKA who were considered low risk for … The authors Diabetic ketoacidosis (DKA) continues to have high rates of morbidity and mortality despite advances in the treatment of diabetes mellitus.

Given available evidence, subcutaneous insulin therapy for mild/moderate uncomplicated DKA has been highlighted by many institutions as a useful strategy during a pandemic.While IVI has been considered the treatment of choice in DKA, several studies have demonstrated use of subcutaneous rapid acting insulin every 1 to 2 hours is a safe and effective alternative in mild/moderate uncomplicated DKA (Summary of subcutaneous insulin RCTs in DKA and potential strategies in COVID-19Abbreviations: IVI, intravenous insulin; DM1, diabetes mellitus type 1; DM2, diabetes mellitus type 2, SC, subcutaneous; IV, intravenous; DKA, diabetic ketoacidosis; LOS, length of stay.Summary of subcutaneous insulin RCTs in DKA and potential strategies in COVID-19Abbreviations: IVI, intravenous insulin; DM1, diabetes mellitus type 1; DM2, diabetes mellitus type 2, SC, subcutaneous; IV, intravenous; DKA, diabetic ketoacidosis; LOS, length of stay.Published studies of subcutaneous insulin use in DKA have used similar protocols but with important differences (Of interest, none of these studies employed the use of an intermediate or long-acting basal insulin rapid-acting insulin analog-driven protocol to prevent rebound hyperglycemia and/or ketoacidosis (It is important to note that the subcutaneous insulin treatment modality has only been studied and recommended in uncomplicated patients with mild/moderate DKA as delineated above and in Severe DKA, in addition to other forms of hyperglycemic crisis, requires management in an ICU with access to IVI, frequent blood, or capillary glucose monitoring (eg, every 1-2 hours), frequent laboratory monitoring (eg, for potassium and electrolytes), and access to respiratory support and cardiac monitoring as needed.
We recently reported that treatment of patients with mild and moderate DKA with hourly injections of SC lispro insulin is as effective as treatment with low-dose IV regular insulin .

She was prescribed azithromycin and hydroxychloroquine, but due to worsening dyspnea, fever, and anorexia sought further evaluation. In the case of DKA, ketosis, acidosis, and elevated fatty acids all contribute to insulin resistance (As noted, DKA due to the use of SLGT2 inhibitors has led to DKA in the absence of marked hyperglycemia reported in hospitalized patients (The ADA classifies the severity of DKA as mild, moderate, or severe based on the extent of acidemia as measured by pH and/or bicarbonate deficit and alteration in a patient’s mental status (Patients experiencing hyperglycemia who are armed with ketone testing at home are better able to communicate with their care team on the severity of their illness when inpatient care is being considered. Useful resources Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis … When DKA resolved he transitioned to a weight-based basal bolus insulin regimen with 0.7 units/kg TDD.

For those with uncomplicated mild/moderate DKA, strategic use of subcutaneous insulin is supported by high-quality evidence and can be useful to address the unique needs of care systems during a pandemic. endstream endobj startxref Brigham and Women’s Hospital and Harvard Medical School, Division of Endocrinology, Diabetes and Hypertension IL-6 levels have been shown to be elevated in both DKA and COVID-19, and may be an important prognostic factor.

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