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Arterial Ph less than 735

Electrolytes + anion Gap:

· Defined as Na7(CL+1 -1CO3) greater than [2.

· The reduction in HCO3 is proportional to the increase in concentration
keto acids and
therefore , the anion gap decrease in HCO3

Treatment of Ciabetic ketoacidosis

A. Gclis of therm
1. Re-hydration
0. Correction of acidernia
1. Normalization of serum glucose
2. Restoration of electrolyte homeostasis
3. Elimination of the underlying cause
B. Managment Cta4eline
1. Make a clear diagnosis (blood gas: blood sugar; anion gap; serum ketones)
§ Admit to HIDLI/ELW
I Frequent monitoring of maternal blond prEssu re, heart rite, pLri4 oNiinctry and
continuous electronic fetal monitoring (as appropriate based OD gtstational ago.
4. Hourly intake and output. Foley catheter should be placed in all £eve.reIy obtunded
or COMIltose patients.
5. Other labs as indicated include liver function test, chest x-ray, sepsis work-up and
cull arcs.
6, Fluid replacement (TO START IN ER)
(0 9,''S ONLY)
·: Over firstiUnins: I litre
.:4 Over next Junto': I fifty
§ Oyer next 2 hours: 50.0 InLihr
4. Over irlexi .1-6 hours; 250 mlikr to replace NA deficit, tri correct
lzypote,fsion, Ari l Increase urine output (If fon!)
b. After BP and urine output stabilize may change fluids to (L45% NS at 250-
SOOcvihr and i lien rnay dc.Le rose infusion railer
0. Goal is correction of total fluid deficit over 12-24 hours, Typical needs range
between 6-8 litres.
c. When blood sugar falls below 15mmo1.1, add 5% Dextrose to IV fluids 11 5,
045%NS) at 1.50-250miihr ra help prevent cerebral cw.dem a caused 11:v rapid
decrease in glucose, Insulin infusion should be continued to keep serum glucose
between 8.3mmolil and 11.1mmolil until meinholic control is achieved.
42. Avoid lactate-containing solution as this will aggravate lit: