Diagnostic Procedures

The following basic diagnostic steps are needed usually during the first 24 hours: clinical history, physical examination, clinical chemistry including TSH, parameters of sepsis, blood gases, urine status, blood and urine cultures in case of signs of infection, ECG, ultrasound of the abdomen, chest X-ray and eventually echocardiography. Especially in the beginning of the therapy of diabetic ketoacidosis, regular control of capillary blood glucose, potassium, and blood gases is needed. Initially, the blood glucose should be controlled every hour or if needed even more frequently, especially to monitor a gradual decrease of blood glucose. In cases where the individual insulin need of the patient is known and the patient is not anymore in severe danger, the time span of controls can be widened. As long as a continuous insulin infusion is running, an hourly control of blood glucose levels is recommended. In cases where the preceding blood glucose levels are in the stabile target level, one can measure every other hour. Serum concentration of potassium, sodium, venous BGA (pH-value, bicarbonate levels) should be determined every 2 to 3 hours during the first days and then every 4 to 8 hours as needed.

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