DKA

Question 1

diagnosis of DKA

Answer 1

blood glucose > 11 or knwon diabetes

capillary ketones > 3mmol/L or urine > 2

venous pH <7.3 or venous bicarb <15mmol

Question 2

history in DKA

Answer 2

been diagnosed with diabetes?
had prev admission with DKA
been taking meds for diabetes?
any allergies?

Question 3

blood tests for ? DKA

Answer 3

FBC
U+E
glucose
VBG
CRP
preg test
blood ketones if available

Question 4

immediate management of DKA

Answer 4

fixed rate insulin and continue long acting insulin in all casess

IV fluids (bolus if <90 BP)

potassium with IV fluids

Question 5

target glucose in DKA

Answer 5

fall of >3mmol per hour until <14

Question 6

target cap ketones DKA

Answer 6

fall >0.5MMOL UNTIL <0.6MMOL

Question 7

venous bicarb targets

Answer 7

> 3mmol rise until >15mmol

Question 8

non pharmaCOLOGICAL management of DKA

Answer 8

MONITORING

- hourly vital signs and check blood glucose, potassium bicarb and ketones

Question 9

referrals of DKA

Answer 9

Discuss with senior member of the team

Contact critical care outreach team

Referral to Medical team

Consider referral to
Intensive Care Unit (ICU) if:

Question 10

WHEN to refer DKA to ICU

Answer 10

Failure to respond to medical management

Patient requires ventilator support

Patient requires blood
pressure support

Deterioration of blood gas following medical management

Question 11

further management of DKA

Answer 11

IF PATIENT is newly diagnosed diabetic then refer to diabetes team to initiate subcut insulin

ensure patient has outpatient follow up with diabetes team prior to dishcarge