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



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