How do I get potassium for ketoacidosis? Diabetic ketoacidosis is not high potassium, and potassium

2) Acid correction should not be too early. Because the acidosis of this disease is based on insulin deficiency, excessive ketoacid production, not excessive HCO3 loss, insulin is used to inhibit ketone production and promote ketoacid oxidation, and the acidosis is corrected by itself, so it is not advisable to supplement too much alkali too early. And too much premature supplementation of sodium bicarbonate (NaHCO3) has the following disadvantages:

Large amounts of NAHCO3 tend to cause hypokalemia; paradoxical hypoph of cerebrospinal fluid; Sodium overload; reactive alkalosis; Inhibition of hemoglobin dissociation in the oxygenated system and tissue hypoxia; Causes cerebral edema. Therefore, when the pH is greater than that, it is not advisable to supplement alkali, and if the pH is lower or the carbon dioxide binding force is less than that, alkali should be supplemented, and sodium bicarbonate should be used instead of sodium lactate. Generally, 100ml of 5% sodium bicarbonate is given intravenously.

1) Establish special care. Closely monitor blood pressure, heart rate, respiration, body temperature, mental status, blood glucose, urine output, urine glucose, urine ketones, blood gas analysis and electrolytes. Blood pressure, breathing, and pulse are measured every hour; Recording incoming and outgoing amounts; Check urine glucose and ketones every 2 hours, and blood glucose and electrolytes every 2 to 4 hours.

2) Oxygen inhalation. In comatose patients, attention should be paid to suctioning to keep the airway open. Turn over and pat your back frequently to prevent pressure sores and pneumonia. (3) Gastric tube intubation for gastric dilators.

4) Insertion of urinary catheter for urinary retention.

5) In addition, it is not advisable to reduce blood sugar and replenish lye in a hurry, so as to avoid complications such as hypokalemia, hypoglycemia, hypoosmolality and cerebral edema; For patients who have just stopped infusion, insulin 4 8u should be injected subcutaneously before going to bed at night to prevent ketones from appearing in the early morning of the next day.

Osmotic diuresis causes large amounts of potassium to be excreted.

Vomiting leads to potassium loss.

Insulin transfers potassium into the cells, so potassium should be supplemented.

Diabetic ketoacidosis should be performed as soon as it is diagnosed**. **The goal is to correct water and electrolyte imbalances, correct acidosis, promote glucose utilization with insulin supplementation, and seek and remove stressors that predispose to ketoacidosis. 1.

General management is monitoring of blood glucose, blood ketones, urine ketones, electrolytes, and arterial blood gases. 2.Rehydration is important in patients with severe ketoacidosis, not only to correct dehydration, but also to help lower blood glucose and eliminate ketones.

The amount of fluid given should vary from patient to patient depending on the degree of water loss. 3.Supplementation with insulin in small doses of insulin** maximally inhibits ketone production without causing hypoglycemia and hypokalemia, and when blood glucose drops, 5% glucose solution is initiated, and the addition of calories is beneficial for ketone correction.

4.In the process of correcting electrolytic disorders**, the changes in serum potassium should be closely monitored, and ECG monitoring can sensitively reflect the level of serum potassium from the changes in the T wave, which is conducive to timely adjustment of the concentration and speed of potassium supplementation. 5.

The biochemical basis for correcting acid-base imbalance diabetic ketoacidosis is excessive ketone production, not excessive HCO3- loss, ** insulin should be used mainly to inhibit ketone production and promote the oxidation of ketone bodies, and the oxidation of ketone bodies produces HCO3-, and acidosis is corrected spontaneously. Giving NAHCO3 too early and too much is harmful. 6.

**Triggers**For ketoacidosis patients**In addition to actively correcting metabolic disorders, it is also necessary to actively seek out predisposing factors and respond accordingly**, such as severe infection, myocardial infarction, surgical diseases, gastrointestinal diseases, etc. Infection is the most common trigger, and sensitive antibiotics should be used early.

Diabetic ketoacidosis**.

Here's how:

1. Fluid should be rehydrated immediately: normal saline should be applied, and the amount of fluid rehydration can be estimated at 10% of the original body weight; The infusion speed is fast first and then slow; When blood glucose drops to millimol liters, 5% glucose solution is transfused instead.

2. Intravenous insulin: insulin is added to the liquid in a small dose of units (kilograms·hour) and continuously intravenous infusion; Generally, the amount of insulin before the disappearance of ketones is 4 6 units per hour, which can reduce blood sugar by millimoles per hour; After the urine ketones disappear, the insulin dose should be 2 to 3 units per hour to avoid hypoglycemia and cerebral edema caused by the rapid drop of blood glucose.

3. Pay attention to maintaining electrolyte acid-base balance: Ketoacidosis will cause severe potassium loss, and potassium can be supplemented when urine. Generally, there is no need to actively supplement alkali when pH

4. Complications such as cerebral edema, heart rhythm disorders, heart failure, and gastrointestinal bleeding.

5. When the vital signs are stable, they should be sent to the ward immediately.

Diabetic ketoacidosis is an acute complication of diabetes that occurs regardless of how long the diabetes has been present. The most common cause of diabetic ketoacidosis is infection, such as cold, cough, and urinary tract infection. The second is the improper application of insulin in the process of diabetes**, such as inappropriate reduction or interruption**; Some other triggers include:

Overeating, alcoholism, surgery, anorexia, trauma, fractures, anesthesia, pregnancy, overwork, etc. The manifestations of diabetic ketoacidosis include extreme thirst, increased urination, significant weight loss, and general fatigue in the early stages. At this stage, if the patient is not vigilant and does not time**, the condition will continue to deteriorate, and within 2-4 days, there will be loss of appetite, nausea, vomiting, abdominal pain, the smell of rotten apples on exhalation, and psychoneurological symptoms such as headache, drowsiness, irritability, etc.

This is followed by severe dehydration, such as decreased urine output, dry mucous membranes, decreased blood pressure, and cold extremities. It can even threaten the patient's life. Once ketoacidosis is found, the patient should be treated as soon as possible, and the patient can be given more water on the way to the hospital, preferably light saline, pay attention to monitoring and recording the patient's blood sugar and urine output, if possible, keep part of the urine sample, and give the doctor a reference after admission.

**: First, the active hydration doctor will first supplement the patient with normal saline, and when the blood sugar drops, switch to 5% glucose and insulin hormone to continue the injection; Second, correct acidosis and water and electrolyte metabolism disorders, and replenish potassium and alkali. Third, monitor blood sugar every two hours, measure urine ketone bodies and urine glucose, pay attention to electrolyte and blood gas changes, and do liver and kidney function, electrocardiogram and other examinations, so as to adjust the ** plan in time.

Prevention: Insulin should be used rationally, and insulin should never be stopped or reduced. Stick to regular self-monitoring of your blood glucose.

Shanxi Diabetes Medical Network.