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Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome – clinical guidelines
Author(s) -
De Beer Karen,
Michael Sindhu,
Thacker Meera,
Wynne Elizabeth,
Pattni Caroline,
Gomm Mandy,
Ball Carol,
Walsh Dominic,
Thomlinson Andrew,
Ullah Kevin
Publication year - 2008
Publication title -
nursing in critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.689
H-Index - 43
eISSN - 1478-5153
pISSN - 1362-1017
DOI - 10.1111/j.1478-5153.2007.00259.x
Subject(s) - medicine , diabetic ketoacidosis , guideline , intensive care medicine , resuscitation , multidisciplinary approach , clinical practice , insulin , nursing , emergency medicine , social science , pathology , sociology
Background: The aim of this study was to establish a standardized approach to the initial care of patients with diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS). DKA and HHS are metabolic emergencies. Effective and efficient management is the responsibility of the multidisciplinary team. The admission of patients to the intensive care unit (ICU) with DKA and HHS is rare, and management of patients’ diverse problems is prone to error because of a lack of familiarity. Aim: The paper’s aim is to set the developmental process of a clinical guideline following a review of the literature. Discussion: This clinical guideline is based on a review of the evidence available within the literature in the early phase of resuscitation. Collaborative working among the multidisciplinary team through clinical practice group was the method adopted. Management of DKA and HHS is divided into three main areas: intravenous fluid replacement, insulin therapy and electrolyte management. The controversy associated with the administration of sodium bicarbonate is discussed. Conclusion: Effective treatment requires a rapid initial assessment of the patient based on current medical history and clinical presentation. To this end, a quick reference algorithm and guide to management were also developed. Key criteria for evaluating the effectiveness of treatment are provided and complications of treatment are addressed. The formation of the practice development group that led to this innovation is outlined, and in conclusion, the success of the group is reflected upon.