DIABETIC KETOACIDOSIS Flashcards
Key Concepts
Severe dehydration
Significant total-body potassium deficiency
Avoid intubation due to Kaussmaul breathing
Most common trigger is infection
MANAGEMENT
Bolus isotonic crystalloid 30 ml / kg followed by twice maintenance
If potassium is greater than 5.5 start insulin
If potassium is between 3.5-5.5 mmol/L, add potassium at 20 mEq/L to each liter of maintenance fluid after the initial bolus
If potassium is less than 3.5 replenish potassium before giving insulin
If glucose drops below 13.9 mmol/L before correction of acidosis, add D5W to maintenance fluids.
Supplement with potassium as needed to maintain a potassium level of at least 3.5 mmol/L before starting insulin infusion.
Regular Insulin infusion at 0.05-0.1 units/kg/h.
Continue insulin infusion until two of the following conditions are met:
Serum bicarbonate ≥15 mmol/L
pH >7.3
Anion gap ≤12 mmol/L
After resolution of DKA has been established according to repeat lab testing, give long-acting insulin, subcutaneously, 2 h before discontinuation of insulin infusion
Give sodium bicarbonate only if the patient has severe hyperkalemia, cardiac arrest, or profound shock from acidosis.
Fingerstick glucose q 1 hr
Lytes q 2
Neuro checks q1-2 hrs assess acidosis, anion gap, and potassium
DOCUMENTATION
Glucose > 13.9 mmol/L
pH < 7.3
Serum Bicarbonate < 18 mEq/L
Serum Ketones
Urine Ketones
Anion Gap > 17 mEq/L
