الحماض الكيتوني السكري في مرحلة الفشل الكلوي الأخيرة: عندما يفشل التسريب الأولي للأنسولين في تحقيق الانخفاض المطلوب للجلوكوز

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.
• In this circumstance, continuous cardiac monitoring is essential and critical care or the specialist renal team should be involved to consider urgent haemodialysis / haemofiltration.
• However, the rate of glucose reduction is the same as for people with preserved renal function – i.e. 3.0 mmol/L/hour.