علاج الحماض الكيتوني السكري في مرحلة الفشل الكلوي النهائي أو لدى المرضى على غسيل الكلى المستمر

References

When DKA does occur in end stage renal disease, several issues need to be considered.

For people with end stage renal failure or those on dialysis, insulin replacement is the mainstay of treatment. This should be given as a FRIII at an initial rate of 0.1 units/kg/hr, but may need to increase if the required rate of glucose fall is not achieved.

If the rate of fall is faster, or the glucose falls to <14.0 mmol/L strongly consider reducing the rate of intravenous insulin infusion to 0.05 units/kg/hr.

Therefore there may be no need for fluid replacement in those with end stage renal failure or those on dialysis.

However, for those who are deemed hypovolaemic, aliquots of 250 ml (0.9% sodium chloride or 10% dextrose) may be given with frequent clinical assessments.

Potassium supplementation is not usually required because the lack of the osmotic diuresis means that there is significantly less potassium loss that for those with preserved renal function.

However, the rate of glucose reduction is the same as for people with preserved renal function – i.e. 3.0 mmol/L/hour.

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