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)
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