MANAGEMENT OF DIABETIC KETOACIDOSIS

Table 1.  Immediate management of diabetic ketoacidosis in adults.⁹

Diagnostic criteria: all three of the following must be present

•capillary blood glucose above 1L mmol/L

•capillary ketones above 3 mmol/L or urine ketones ++ or more

•venous pH less than 7.3 and/or bicarbonate less than 15 mmol/L

Action 1: initiate 0.9% sodium chloride solution using following regime:

•500ml over 10–15 minutes if systolic blood pressure is below 90 mmHg. Repeat and request senior input if systolic blood pressure remains less than 90 mmHg.

•Once systolic blood pressure is greater than 90 mmHg, give 1L over first 60 minutes

•1L with potassium chloride over next 2 h

•1L with potassium chloride over next 2 h

•1L with potassium chloride over next 4 h

•add 10% glucose 125 ml/h if blood glucose falls below 14 mmol/L

Action 2: commence fixed rate intravenous fast acting insulin of 0.1 units/kg/h based on an estimation of the patient's weight

Action 3: assess patient with full set of observations including Glasgow Coma Score and full clinical examination

Action 4: further investigations, including venous glucose, renal function, full blood count, blood cultures, electrocardiogram, chest radiograph and urine culture

Action 5: establish monitoring system, including hourly capillary blood glucose, hourly capillary ketone measurement if available and venous bicarbonate and potassium at 60 minutes, 2 h and 2 hourly thereafter, and 4 hourly plasma electrolytes. Consider continuous cardiac monitoring and pulse oximetry if appropriate.

Action 6: consider and treat potential precipitating complications