Steps in DKA management

This post will only detail the steps that you need to make sure you go through when managing a patient with DKA, it will not go into any specific details regarding doses / frequency / timing.

1. Resuscitation / iv fluid therapy

– A/B/C – patients might present with circulatory collapse / altered mental state due to severe acidosis / metabolic disturbances (especially hypo or hyperK)

– early iv fluid resuscitation / therapy is very important; however be aware of the risk of cerebral oedema (especially in children) and exercise caution after the 2nd liter of fluid in adults and in children only give 10 mls/kg boluses then review carefully

2. Insulin therapy

– as per the local protocol; usually 0.05 – 0.1 units/kg/hr; the use of a bolus dose is controversial as it might increase the risk of cerebral oedema

– start with a lower dose in patients in renal failure

3. Dextrose – to start when BSL <15.0 mmol/L; consider using 10% instead of 5% if the patient is fluid overloaded or at risk of cerebral oedema

4. Electrolyte replacement

– K (caution if already low when you start insulin as it will drop further, or if in acute renal failure or anuric)

– phosphate

– Mg

5. Look for the cause of decompensation – infection / CNS event / alcohol binge etc.

6. Monitor closely for complications of therapy – hypoglycaemia / rapid shift in electrolytes with arrhythmia or altered mental state / seizures / cerebral oedema