Diabetes is a common chronic disease, but have you heard of diabetes ketoacidosis? Diabetes ketoacidosis is one of the most serious complications of diabetes, which mostly occurs in insulin dependent patients. For coma patients with diabetes ketoacidosis, good nursing is an important link in the treatment of ketoacidosis. So, what does it mean to supplement alkali for diabetes ketoacidosis? What about diabetes ketoacidosis?
1. Fluid replacement
The purpose of DKA fluid replacement is to expand the volume. Correct dehydration, reduce blood osmotic pressure, and restore effective blood volume. Quickly establish 2-3 venous channels, correct water and electrolyte imbalances, maintain acid-base balance, correct ketosis and other treatments. A dedicated intravenous channel must be used to administer insulin for dose control. Generally, isotonic sodium chloride solution should be administered first. At the beginning, the infusion rate should be fast, and 1000-2000ml of blood volume should be replenished within 2 hours to improve peripheral circulation and renal function. Afterwards, the infusion volume and speed should be determined based on blood pressure, heart rate, hourly urine output, and if necessary, central venous pressure. Input 1000-2000ml from the 2nd to the 6th hour, and replenish 4000-5000ml of fluid on the first day, even up to 8000ml. Individuals with low blood pressure or shock can receive colloidal solution. When blood sugar drops to around 13.9mmol/L, 5% GS can be administered to prevent hypoglycemia.
2. Correcting acidosis
Mild cases can gradually correct acidosis after treatment with fluid replacement and insulin, without the need for alkaline supplementation. Severe acidosis causes peripheral blood vessel dilation and reduces myocardial contractility, leading to hypothermia and hypotension, as well as decreased insulin sensitivity. Moderate sodium bicarbonate should only be administered when the blood pH drops to 7.1-7.0 or when the bicarbonate concentration is below 5mmol/L.
3. Potassium supplementation
A significant increase in blood sugar can cause osmotic diuresis, and potassium is excreted with urine; Vomiting can also cause potassium loss; Not eating potassium cannot compensate for the worsening potassium deficiency, so potassium supplementation is necessary. However, due to acidosis, intracellular potassium is transferred to the extracellular space, hepatic glycogen is broken down to release potassium, and poor peripheral circulation leads to oliguria. Therefore, blood potassium may not decrease temporarily, and potassium supplementation is not necessary at the beginning. According to blood potassium, electrocardiogram, urine volume, etc., grasp the time and amount of potassium supplementation, and ensure that potassium is replenished upon seeing urine. The infusion speed should not be too fast, and the concentration should not exceed 500ml. Add 1.5g potassium chloride to the solution, and avoid static pushing or extravasation outside the blood vessels.
