Diabetic Ketoacidosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
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Step-wise approach to management of diabetic ketoacidosis
| DKA treatment protocol according to ADA guidelines | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fluids | Bicarbonate | Insulin | Potassium | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hydration status | pH greater than equal to 6.9 | pH less than 6.9 | 0.1 u/kg/B.WT. as IV bolus | 0.14 u/kg/B.WT/hr as continous IV infusion | K < 3.3 mEq/L | K = 3.3 - 5.2 mEq/L | K > 5.2 mEq/L | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Severe hypovolemia | Mild dehydration | Cardiogenic shock | 0.1 u/kg/B.WT. as IV continous infusion | Hold insulin and give 20-30mEq/L of potassium until K+ > 3.3mEq/L | Give 20-30mEq/L in each liter of IV fluids to maintain serum K 4-5mEq/L | Do not give potassium but check serum potassium every 2 hours | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 0.9% Nacl (1L/hr) as IV infusion | Check corrected serum sodium | Hemodynamic monitoring and add pressors accordingly | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If serum glucose does not fall by 10 % within one hour of therapy then give 0.14 U/Kg as IV bolus and continue previous regimen | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| High serum Na (>145 mEq/L) | Normal serum Na (135-145 mEq/L) | Low serum Na (< 135 mEq/L) | When serum glucose drops to 200 mg/dl, reduce regular insulin to 0.02-0.05 U/Kg/hour, or give rapid-acting insulin at 0.1 U/kg SC every 2 hours, maintain serum glucose between 150 mg/dl to,200 mg/dl until resolution | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 0.45% NaCl (250-500 ml per hour depending on hydration status | 0.9% NaCl (200-500 ml per hour) depending on hydration status | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| When serum glucose decreases to 200 mg/dl, switch to 5% dextrose with 0.45% NaCl at 150-250 ml/hour | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
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Don'ts
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