Fluid and Electrolyte Management in Diabetic Ketoacidosis...

Fluid and electrolyte management in Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic state in the emergency department Introduction Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie Samaras, 2009). In Type 2 Diabetes, another equally dangerous†¦show more content†¦ Donelly, R., 2010). As with DKA, at this stage the body attempts to normalize the osmolality through diuresis, which leads to dehydration, loss of electrolytes, and further hyperosmolality. With HHS evolving over days to weeks, (often either through poor medication compliance/inappropriate prescribing, dietary issues, or illness), the effect is insidious, and often by the time a patient presents to the emergency department either directly or via a GP, they are already critical (Kisiel, M. Marsons, L., 2009). Further complicating the diagnosis and treatment can be a mixed picture of both HHS and DKA. This occurs in both type 1 diabetes and Type 2 diabetes. In this case treatment is balanced between correcting the metabolic acidosis and lowering the osmolality of the blood. (Kearney T. Dang, C., 2007) In both conditions (and in a mixed picture of both), the dehydration can be further exacerbated by the resulting Nausea and vomiting, meaning further fluid loss, and critically decreased fluid intake (Lowth, M. 2012). Both conditions require emergency treatment. Correcting the fluid deficit Irrespective of the potential metabolic acidosis, Initial management of both DKA and HHS is focused on rehydration. The aim is to replace fluids in the both the intravascular and extra vascular spaces, while simultaneously diluting glucose levels (and thus lower osmolality) and counter-regulatory hormones (Raghavan, 2014) The Monash Health HHS DKA