Diabetic Ketoacidosis
Fluid Replacement:
- Give 2 Litres of Isotonic Saline (0.9%) over the first 4 hours
- Give 2 Litres over the next 8 hours then 1 Litre every 8 hours
- Consider Colloid if systolic blood pressure
- Use Hypotonic Saline only very cautiously (plasma Na >155mmol/L, 1 litre over 8 hours
- Be more cautious in the elderly
Insulin:
- Infuse initially 20U IM followed by 6-10 U each hour
- Double the dose if no response in 2-4 hours
Potassium:
- Give 20mmol/h from the time of initiation of insulin infusion
- Discontinue temporarily if labrotarory K + >6.0mmol/l
- Check every 2 hours
- If potassium falls to
- Monitor ECG
Bicarbonate:
- Only use if PH is 6.9 or less
- If indicated, give 100mmol with 20mmol K + over minute
- Repeat blood gases and plasma K + 30min later
- Infection
- Arrange Urinalysis, chest X-ray, Blood Cultures
- Do not rely on temperature and leucocytosis
- Use antibiotics even if uncertain
- General Care
- When glucose <230mg/dl:
- Start Glucose-Insulin-Potassium Regime:
- 500ml 10% glucose (dextrose) + 24 Units of Insulin+ 20mmol K + at 80ml/hour
- Aim for blood glucose 180-230 mg/dl by change of insulin dose
- Start Subcutaneous insulin therapy when able to eat
- Insert a nasogastric tube when patient is comatose
- Insert a urinary catheter if no urine passed within 3 hours
- Heparinize if coma, hyperosmolar, other risk factors
- ·Review cause to reduced risk of reoccurrence