DKA

Question 1

Diagnosis for DKA?

Answer 1

Blood glucose >11 mmol
Blood ketones >3 mmol
pH <7.3 (or bicarb <15mmol)

Question 2

Initial management for DKA if pt is alert. not significantly dehydrated and able to tolerate oral intake?

Answer 2

Encourage oral intake

Give sc insulin injection

Question 3

Initial management for DKA if patient is vomiting, confused and/or significantly dehydrated?

Answer 3

1. IV fluid bolus 0.9% normal saline (10mls/kg)
2. Add potassium to 2nd litre of iv fluid is K <5.5
3. Insulin fixed rate infusion at 0.1units/hour 1 hr after starting fluids

If evidence of shock then give initial fluids bolus of 20mls/kg

Do not stop iv insulin infusion untill 1 hours after sc insulin has been given

Prevent hypoglycemia with IV dextrose once blood glucose falls to below 14 mmol

Monitor for signs of cerebral oedema and treat any underlying triggers like sepsis