The principle of treatment for diabetic ketoacidosis (DKA) is to replenish fluids as soon as possible in order to restore blood volume, correct the state of water loss, insulin hypoglycemia, correct the electrolyte and acid-base balance imbalance, and at the same time, actively search for and eliminate the causative factors, prevention and treatment of complications, and proper nursing care to reduce the morbidity and mortality rate.
1. Rehydration: it is the key link of treatment. Only after the effective tissue perfusion is improved and restored, the biological effect of insulin can be brought into full play. The basic principle is “fast then slow, salt then sugar”.
2. Insulin treatment:
Generally, small-dose (short-acting) insulin therapy is adopted to keep the serum insulin concentration at a constant level of 100-200 µU/ml, and when the blood glucose drops to 13.9 mmol/L, 5% dextrose solution is inputted and insulin is added proportionally to stabilize the blood glucose level in a safer range. Transition to insulin routine subcutaneous injection after stabilization.
3. Correct electrolyte and acid-base balance imbalance:
Ketoacidosis is mainly caused by acidic metabolites in ketone bodies, after infusion and insulin treatment, the ketone body level decreases, acidosis can be self-corrected, and generally do not need to replenish alkali. However, severe acidosis affects the cardiovascular, respiratory and nervous system function, and should be given appropriate treatment, and the indications for alkali supplementation are blood pH <7.1, HCO₃- <5mmol/L.
4. Handle the predisposing disease and prevent complications:
In the process of resuscitation, attention should be paid to the coordination of therapeutic measures and the importance of preventing and treating important complications from the beginning, especially cerebral edema and renal failure, and maintaining the function of important organs.
5.Nursing:
Good nursing care is an important part of rescuing DKA. Oral and skin should be cleaned on time to prevent pressure sores and secondary infections. Observe the changes of condition carefully, and record the mental state, pupil size and reaction, vital signs, water in and out accurately.
Diabetic ketoacidosis is a serious acute complication of diabetes mellitus, which requires timely hospitalization to prevent life-threatening delays.