Diabetic Ketoacidosis in Children May Lead to Cognitive Impairment.

Avoiding kidney, brain, and other organ damage depends on prevention.

Eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas / Effectiveness of patient-directed nursing protocols with diabetic complications / Eficacia de los protocolos de enfermería dirigidos al paciente con complicaciones diabéticas

Objetivo: Investigar na literatura científica a eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas. Método: Revisão integrativa, realizada de agosto a setembro de 2019, seguindo as recomendações do PRISMA. As bases de dados utilizadas foram: Web of Science e Scopus, através dos cruzamentos: "Diabetes Mellitus AND Nursing AND Protocols" e "Amputation AND Nursing AND Protocols". Identificaram-se 672 artigos, sendo selecionados 17. Resultados: A maior parte dos estudos foram publicados em inglês e realizados nos Estados Unidos. Verificaram-se protocolos de controle glicêmico, da cetoacidose e do autocuidado, os quais apresentaram bons resultados para o que se propõem. Um artigo abordou superficialmente os cuidados de enfermagem direcionados a pessoas com amputação. Conclusão: Os protocolos de enfermagem direcionados ao paciente com complicações diabéticas apresentaram-se eficazes.

Objective: To investigate in the scientific literature the effectiveness of nursing protocols directed to patients with diabetic complications. Method: Integrative review, conducted from August to September 2019, following the recommendations of the PRISMA.The databases used were: Web of Science and Scopus, through the crossovers: "Diabetes Mellitus AND Nursing AND Protocols" and "Amputation AND Nursing AND Protocols". A total of 672 articles were identified and 17were selected. Results: Most studies were published in English and conducted in the United States. Glycemic control, ketoacidosis and self-care protocols were verified, which presented good results for their purpose. One article superficially addressed nursing care directed to people with amputation. Conclusion: Nursing protocols directed to patients with diabetic complications were effective

Objetivo: Investigar en la literatura científica la efectividad de los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas. Método: Revisión integradora, realizada de agosto a septiembre de 2019, siguiendo las recomendaciones de PRISMA. Las bases de datos utilizadas fueron: Web of Science y Scopus, a través de los crossovers: "Diabetes Mellitus AND Enfermería AND Protocolos" y "Amputación AND Enfermería AND Protocolos". Se identificaron un total de 672 artículos y se seleccionaron 17. Resultados: La mayoría de los estudios se publicaron en inglés y se realizaron en los Estados Unidos. Se verificaron los protocolos de control glucémico, cetoacidosis y autocuidado, que presentaron buenos resultados para su propósito. Un artículo abordó superficialmente la atención de enfermería dirigida a personas con amputación. Conclusión: Los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas fueron efectivos

Hyperglycemia Syndromes.

Diabetes mellitus and its complications are among the leading causes of organ failure around the world. It is imperative that timely, patient-centered care is provided to avoid microvascular and macrovascular damage. People with well-controlled diabetes can live long and healthy lives through interprofessional management, emphasizing optimal, individualized care.

Children and young people with diabetes: recognition and management.

Diabetes mellitus (type 1) is an autoimmune condition leading to absolute insulin deficiency resulting in hyperglycaemia and its associated manifestations. It is the most common type of diabetes seen in children, characterised by the 4Ts (toilet, thinner, thirsty, tired). The signs and symptoms can sometimes be non-specific and a delay or missed diagnosis may be catastrophic to the health of the child. Children with an established diagnosis of diabetes often present to the health service with issues such as hypoglycaemia, hyperglycaemia, or diabetic ketoacidosis. The condition requires life-long monitoring and strict control of blood glucose levels with insulin replacement therapy, with the aim of achieving an HbA1c level of 48 mmol/mol. There are often physical and psychosocial issues that arise from the diagnosis leading to poor control. Nurses working in different clinical settings play a vital role in raising suspicions of diabetes leading to timely diagnosis and rapid initiation of treatment. They are best placed to provide essential support in helping children and their families to come to terms with the diagnosis, as well as manage this chronic condition by addressing the common issues that arise in the ongoing management, with a particular emphasis on managing the various day-to-day challenges. Two case studies are included to highlight some of the challenges that nurses may encounter while managing children with diabetes.

National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014.

AIM: To examine, in a national survey, the outcomes of adult patients presenting with DKA in 2014, mapped against accepted UK national guidance. METHODS: Data were collected in a standardized form covering clinical and biochemical outcomes, risk and discharge planning. The form was sent to all UK diabetes specialist teams (n = 220). Anonymized data were collected on five consecutive patients admitted with DKA between 1 May 2014 and 30 November 2014. RESULTS: A total of 283 forms were received (n = 281 patients) from 72 hospitals, of which 71.4% used the national guidelines. The results showed that 7.8% of cases occurred in existing inpatients, 6.1% of admissions were newly diagnosed diabetes and 33.7% of patients had had at least one episode of DKA in the preceding year. The median times to starting 0.9% sodium chloride and intravenous insulin were 41.5 and 60 min, respectively. The median time to resolution was 18.7 h and the median length of hospital stay was 2.6 days. Significant adverse biochemical outcomes occurred, with 27.6% of patients developing hypoglycaemia and 55% reported as having hypokalaemia. There were also significant issues with care processes. Initial nurse-led observations were carried out well, but subsequent patient monitoring remained suboptimal. Most patients were not seen by a member of the diabetes specialist team during the first 6 h, but 95% were seen before discharge. A significant minority of discharge letters to primary care did not contain necessary information. CONCLUSION: Despite widespread adoption of national guidance, several areas of management of DKA are suboptimal, being associated with avoidable biochemical and clinical risk.

Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome.

PURPOSE: This practice improvement project was formulated to determine accuracy rate in differentiating between two hyperglycemic crises (diabetes ketoacidosis [DKA] and hyperosmolar hyperglycemic nonketotic syndrome [HHNKS]) in a clinical population of individuals who manifested hyperglycemia and diabetes mellitus (DM). We hypothesized that HHNKS was commonly misdiagnosed as DKA. Our primary aim was to determine frequency of correct HHNKS diagnoses. A second aim was to review the literature and present an evidence-based protocol to assist providers with the differential diagnosis of HHNKS from DKA. DATA SOURCES: Electronic health records (N = 911) were selected by ICD-9 codes for hyperglycemia, DKA, and HHNKS. A retrospective record review indicated n = 436 met the blood glucose level depicting HHNKS. Additional laboratory findings were compared with diagnostic criteria from the literature. CONCLUSIONS: HHNKS was commonly misdiagnosed and mismanaged as DKA. Only n = 9 (5%) patients with type 2 DM were correctly diagnosed and managed as having HHNKS. Of the records misdiagnosed with DKA, 74 (39%) actually manifested HHNKS clinical features. Of these, n = 24 (36%) were readmitted within 2 weeks. IMPLICATIONS FOR PRACTICE: Early recognition of HHNKS is essential for appropriate condition management. HHNKS-specific algorithms are essential for expediting accurate diagnosis, managing appropriately, minimizing mortality, reducing stay length, and avoiding readmissions.

Management of diabetic ketoacidosis in adults.

Ketoacidosis is a serious complication of diabetes. It is commonly precipitated by poor adherence to medication, stress and concurrent illness; it can be life threatening if it is not addressed quickly and effectively. This article discusses the pathophysiology, diagnosis and management of the condition, and highlights the nurse's role in this.

Diagnosis and treatment of diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is an acute and serious metabolic complication of type 1 diabetes. Caused by severe insulin deficiency leading to hyperglycaemia, DKA is the most common cause of mortality in people with type 1 diabetes under the age of 40. It causes nausea and vomiting, hypothermia, hypotension, cardiac arrhythmia, tachycardia, deep and rapid breathing and, if untreated, can lead to cerebral oedema, coma and death. The survival of patients with DKA can depend, therefore, on the ability of emergency nurses to recognise its signs and symptoms. The most urgent treatment outcomes in emergency settings are the reversal of ketosis and hyperglycaemia, and the prevention of hypokalaemia and hyponatraemia, and these should be followed by hourly biochemical tests to determine treatment alterations. This article describes DKA and how patients with the condition usually present, and outlines its treatment by emergency nurses.

Procedures and medications to help patients control their diabetes.

Two of the most common acute and potentially life-threatening complications of diabetes mellitus are diabetic ketoacidosis and hyperosmolar hyperglycaemic state. Both conditions are characterised by hyperglycaemic states, but nurses should be aware of important differences so the correct condition and treatment can be identified. Treatment includes immediate referral to specialist diabetes teams and possible transfer to intensive care. This article outlines the similarities and differences in the symptoms and treatment of the conditions, and discusses prevention strategies.

An overview of diabetic ketoacidosis in children.

Identifying the causation and development of diabetic ketoacidosis (DKA) helps in understanding the signs, symptoms, care and complications of cerebral oedema. Its management requires skilled nursing and involves fluid therapy, intravenous insulin, correction of potassium imbalance and strict vigilance for potentially lethal complications. This article describes the pathophysiology of DKA, identifies its causes, and discusses management and prevention strategies. While the prognosis for DKA is good, it is associated with cerebral oedema, a potentially devastating complication, and this will also be discussed.

Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis.

Changes in health care delivery have shifted the care of pediatric patients primarily to the outpatient setting, with the exception of children and adolescents requiring complex, highly acute care. Thus, nurse educators are challenged to provide nursing students with pediatric learning experiences and are further confounded by the relative paucity of available clinical placements. Nurse educators are exploring the use of simulation to provide realistic alternatives to pediatric clinical experiences. The development of simulation scenarios focused on the care of an adolescent patient presenting with diabetic ketoacidosis is discussed. A review of the current literature addressing the use of simulation in nursing education and the advantages and challenges of designing, implementing, and evaluating simulation scenarios are also discussed.

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome - clinical guidelines.

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.

O manejo da cetoacidose em pacientes com Diabetes Mellitus: subsídios para a prática clínica de enfermagem / Management of diabetic ketoacidosis in Diabetic patients: clinical practice nursing recommendations

A cetoacidose diabética é uma condição aguda e grave que se desenvolve predominantemente em pacientes com Diabetes mellitus do tipo 1 e é induzida pela deficiência relativa ou absoluta de insulina. Ocorre comumente em associação a situações de estresse, que elevam os níveis dos hormônios contra-reguladores e constitui importante emergência clínica, que requer intervenções imediatas e efetivas. Assim, pretende-se, por meio deste artigo, com base na fisiopatologia e nas manifestações clínicas, fornecer subsídios para a prática clínica de enfermagem no manejo da cetoacidose diabética.

Diabetic ketoacidosis is a severeand acute condition in Type 1Diabetes mellitus that is promptedby relative or absolute insulindeficiency. It is frequentlyrelated to stressful situations, inwhich stress hormones are elevated.It is considered a clinicalemergency that requires immediateand effective intervention.This article, based on the physiopathology and the clinical manifestations, aims at providing clinicalpractice nursing recommendationsfor the management ofdiabetic ketoacidosis.

La cetoacidosis diabética es unacondición aguda y grave que sedesarrolla predominantemente enlos pacientes con Diabetes mellitusdel tipo 1 y es inducida por ladeficiencia relativa o absoluta deinsulina. Ocurre generalmenteasociada a situa-ciones de estrés,que elevan los niveles de lashormonas contra-reguladoras,constituyéndose en una importanteemergencia clínica, que requiereintervenciones inmediatasy efectivas. Así, se pretende, pormedio de este artículo, con baseen la fisiopatología y en las manifestaciones clínicas, ofrecer elementos de juicio para la prácticaclínica de enfermería en el manejode la cetoacidosis diabética.