DKA management By RAZZI B. HAJEMI

Case scenario Mr SK 34 year old gentleman, was admitted to ED due to loss of consciousness. A known case of diabetic and hypertension. Experienced vomiting and abdominal pain before loss of consciousness.

Mr SK 34 year old gentleman, was admitted to ED due to loss of consciousness.

A known case of diabetic and hypertension.

Experienced vomiting and abdominal pain before loss of consciousness.

Management plan IV access and start fluid(0.9% saline) replacement immediately. Check plasma glucose: usually >20mmol/L If so, give 4-8u soluble insulin IV Investigation

IV access and start fluid(0.9% saline)

replacement immediately.

Check plasma glucose: usually >20mmol/L

If so, give 4-8u soluble insulin IV

Investigation

investigation Lab glucose, U&E, HCO - 3 , osmolality, blood gases, FBC, and blood culture. urine test: ketones, CXR(pneumonia)

Lab glucose, U&E, HCO - 3 , osmolality, blood gases, FBC, and blood culture.

urine test: ketones, CXR(pneumonia)

NG tube only if nauseated/ vomiting/ unconscious insulin sliding scale Continue fluid replacement, K + replacement Check glucose and U&E, HCO - 3 regurlarly

NG tube only if nauseated/ vomiting/ unconscious

insulin sliding scale

Continue fluid replacement, K + replacement

Check glucose and U&E, HCO - 3 regurlarly

Insulin sliding scale Hourly glucose result (mmol/L) Soluble insulin If infection or insulin resistance 0-3.9 0.5u/h 1u/h 4-7.9 1 2 8-11.9 2 4 12-16.0 3 6 >16 4 8

Fluid replacement Give 1L of 0.9% saline stat. Then typically, 1L over the next hour, 1L over 2 hour, 1L over 4 hour, then 1L over 6 hour. Use dextrose saline or 5% dextrose when blood glucose is <15mmol/L. Those >65yrs or with ccf need less saline more cautiously.

Give 1L of 0.9% saline stat. Then typically, 1L over the next hour, 1L over 2 hour, 1L over 4 hour, then 1L over 6 hour.

Use dextrose saline or 5% dextrose when blood glucose is <15mmol/L.

Those >65yrs or with ccf need less saline more cautiously.

K + replacement Serum potassium (mmol/L) Amount of KCL add per litre of IV fluid <3.0 40mmol 3-4 30mmol 4-5 20mmol