Prevention of diabetic ketoacidosis
1979
Schade, David S. | Eaton, R. Philip
Relative insulin deficiency, stress hormone excess, fasting, and dehydration all contribute to the pathogenesis of ketoacidosis and must be closely monitored for preventive therapy. Ketoacidosis will not develop in diabetic patients who have sufficient circulating plasma insulin concentrations. The patient may have to sustitute regular for intermediate-acting insulin to raise plasma levels. Techniques of controlling the secretion of stress hormones have taken on new importance. Reduction of the stress level is one approach, along with an experimental technique for pharmacologic blockade of stress hormone secretion or activity. Fasting, as a contributing factor, usually is not deliberate. The patient should be advised of the need for proper caloric intake. In cases of nausea and vomiting, clear liquids augmented with sucrose may be better tolerated. Prevention of dehydration is of paramount importance, and if it cannot be prevented immediate rehydration in a medical facility is indicated. Patients should be encouraged to ingest broths and fruit juices for fluid and electrolyte content.
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