| Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. | |
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MedLine Citation:
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PMID: 21255074 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) http://www.diabetes.org.uk/About_us/Our_Views/Care_recommendations/The-Management-of-Diabetic-Ketoacidosis-in-Adults; (ii) http://www.diabetes.nhs.uk/publications_and_resources/reports_and_guidance; (iii) http://www.diabetologists-abcd.org.uk/JBDS_DKA_Management.pdf. This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. |
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Authors:
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M W Savage; K K Dhatariya; A Kilvert; G Rayman; J A E Rees; C H Courtney; L Hilton; P H Dyer; M S Hamersley; |
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Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Diabetic medicine : a journal of the British Diabetic Association Volume: 28 ISSN: 1464-5491 ISO Abbreviation: Diabet. Med. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-12 Completed Date: 2011-07-26 Revised Date: 2012-01-18 |
Medline Journal Info:
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Nlm Unique ID: 8500858 Medline TA: Diabet Med Country: England |
Other Details:
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Languages: eng Pagination: 508-15 Citation Subset: IM |
Copyright Information:
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© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK. |
Affiliation:
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North Manchester General Hospital, Diabetes Centre, Delauneys Road, Manchester M8 5RB, UK.mark.savage@pat.nhs.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose
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metabolism* Body Weight Diabetes Mellitus, Type 1 / diagnosis*, drug therapy, epidemiology Diabetic Ketoacidosis / diagnosis*, drug therapy*, epidemiology Disease Management Great Britain / epidemiology Humans Hypoglycemic Agents / therapeutic use* Injections, Subcutaneous Insulin / therapeutic use* Ketones / blood |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Hypoglycemic Agents; 0/Insulin; 0/Ketones |
| Comments/Corrections | |
Comment In:
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Diabet Med. 2012 Jan;29(1):153; author reply 153-4
[PMID:
21812813
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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