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