Diabetic ketoacidosis

Question 1

In DKA, in order to restore circulating fluid volume if the systolic blood pressure is below 90mmHg, what volume of which fluids should be given?

Over what duration?

Answer 1

500mL sodium chloride 0.9% by IV infusion over 10-15 minutes.

Repeated if BP remains below 90mmHg and seek senior medical advice.

Question 2

In DKA, when the blood pressure is >90mmHg, sodium chloride 0.9% should be given by IV infusion at what rate?

Answer 2

At a rate that replaces deficit and provides maintenance.

Question 3

In DKA, potassium chloride should be included in the fluids, except when what?

Answer 3

When anuria (non-passage of urine) is suspected.

Question 4

In DKA, an intravenous insulin infusion should be started. How is this done?

Answer 4

Soluble insulin diluted thoroughly with NaCl 0.9% IV infusion to a concentration of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour.

Question 5

Should established SC therapy with long-acting insulin analogues be continued during the treatment of DKA?

Answer 5

Yes. Can miss short acting tho.

Question 6

In DKA management, blood-ketone concentration should fall by at least what value each hour?

Answer 6

at least 0.5mmol/litre/hour

Question 7

In DKA management, blood-glucose concentration should fall by at least what value each hour?

Answer 7

at least 3 mmol/litre/hour

Question 8

In DKA management, when would 10% glucose be given by IV infusion? and at what rate?

Answer 8

When blood-glucose concentration falls below 14mmol/litre, at a rate of 125mL/hour alongside the NaCl 0.9% infusion.