How is Hypophosphatemia treated in DKA?

Among the electrolytes that are monitored during DKA management, phosphate is easily overlooked. According to DKA protocol, potassium is recommended to be replaced with a concentration of 20 mmol/L as form of either potassium phosphate with potassium chloride or potassium acetate [5,16].

Why is sodium bicarbonate given for DKA?

Core tip: Serial arterial blood gas measurements and intravenous sodium bicarbonate are often used to assess and correct acidosis associated with diabetic ketoacidosis. The available literature, primarily in patients with mild to moderately severe acidosis, does not support the routine use of sodium bicarbonate.

When do you give bicarbonate of DKA?

Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9.

What causes euglycemic DKA?

Euglycemic diabetic ketoacidosis (EDKA) is an uncommon diabetic complication associated with several risk factors such as fasting, surgery, pregnancy, and now the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors.

What happens to bicarbonate in DKA?

In DKA, bicarbonate is replaced by β-hydroxybutyric acid and acetoacetic acid, so that the sum of bicarbonate and chloride concentrations is reduced and the anion gap is thus increased.

Can a dog recover from diabetic ketoacidosis?

Unfortunately, the long-term prognosis for dogs with diabetic ketoacidosis is very poor. You will need to be extra vigilant of your dog during the treatment and recovery period. Look for untoward symptoms — weight loss, vomiting, skin yellowing — and call your veterinarian immediately if they should occur.

Do you bolus insulin in DKA?

Learning Objectives: The American Diabetes Association (ADA) recommends treating patients for diabetic ketoacidosis (DKA) with or without an insulin bolus followed by a low-dose regular insulin infusion. Limited data suggests a possible increased risk for hypoglycemia in the setting of insulin bolus administration.

What are the signs and symptoms of hypophosphatemia?

Some of the tell-tale signs you might have hypophosphatemia, include:

• Muscle weakness.
• Softening or weakening of bones.
• Chronic depletion.
• Depletion of muscles.
• Issues with the blood.
• Altered mental state.
• Seizures.
• Numbness.

How does hypophosphatemia affect breathing?

The results of our study show that hypophosphatemia causes respiratory muscular weakness (a decrease in the volume of autonomous respiration), reduction of static lung compliance and a loss of respiratory function, leading to weaning failure.

Why is sodium low in DKA?

In DKA, we expect to find normal or low serum sodium due to the dilutional effect of hyperosmolar status caused by elevated blood glucose that shifts water from the intracellular space to the extracellular space.

Can you have DKA with normal bicarb?

While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L.

Does insulin bolus have an effect on DKA?

However, insulin boluses may lead to harm including hypoglycemia, hypokalemia, and if glucose levels are too rapidly corrected, cerebral edema [1]. Since the publication of the ADA consensus statement, two investigations have attempted to answer the question of what affect insulin bolus has on patients with DKA [1] [2].

What is euglycemic diabetes mellitus (DKA)?

Euglycemic DKA is a rare entity that mostly occurs in patients with type 1 diabetes, but can possibly occur in type 2 diabetes as well.

Why is insulin used to treat diabetic ketoacidosis (DKA)?

The rationale for such a bolus is to overcome the relative insulin deficiency seen in DKA in order to suppress lypolysis and hepatic gluconeogenesis and limit further acidosis (more on that next time). However, insulin boluses may lead to harm including hypoglycemia, hypokalemia, and if glucose levels are too rapidly corrected, cerebral edema.

Does the DKA guideline keep up with research?

Guidelines are nice, but they don’t keep up with research…. Since the 2009 DKA guideline…. 2 more studies have come out evaluating the usefulness of sodium bicarbonate in DKA. There has been a systematic review published in 2011 and the largest retrospective analysis ever published in 2013.