Diabetic Ketoacidosis
Definition
Clinical features
Investigations
0 - 1 H
1 - 4 H
4 - 6 H (if indicated)
6 - 24 H
24 - 48 H
Mx
Mx Flowchart
Access here. (source: DHHS Tasmania)
Complications
Source
Dr Ingrid Els 2014
DHHS Tasmania 2014
- ↑glyc
- Ketosis
- Acidosis
- Dehydration (water follows glu)
Clinical features
- Kussmaul breathing (video)
- Vomiting, polydipsia, polyuria
- Ketone breath
- ** cerebral oedema**
- Coma
Investigations
0 - 1 H
- Beside: Urinalysis (glu + ketones), Urine culture (rule out inf as cause)
- Bloods: Serum glucose, VBG (pH/HCO3), UEC (? ↑K+, ↓ Na+), Blood culture, CMP (? ↓PO4), FBC (inf)
1 - 4 H
- Bloods: Serum glucose, UEC, VBG
4 - 6 H (if indicated)
- Bloods: UEC, VBG
6 - 24 H
- Bloods: Serum glucose, UEC, VBG
24 - 48 H
- Bloods: FBC, UEC, HbA1C
Mx
- Fluids
- 10ml/kg N saline
- NO insulin
- Rehydration:
- Add 40mmol/L K+ if K+ ↓ 5.5mmol/L
- Add 5% dextrose if BSL ↓ 12-15 mmol/L
- Fluid req = % dehydrated x 10ml/kg (mild ≈3% mod ≈ 5%, sev ≈ 10%)
- Electrolytes
- Na+
- K+
- HCO3- (rarely used due paradoxical CNS acidosis)
- Insulin
- 0.1U/kg/h after initial bolus
- BSL ↓ 15mmol/L, no ketosis and no acidosis (pH >7.3), , use N saline + 5% dex and SC insulin
- Stop IV insulin 90 min after SC insulin
Mx Flowchart
Access here. (source: DHHS Tasmania)
Complications
- Cerebral oedema
- Dysrhythmia
- Pul. oedema
- AKI
Source
Dr Ingrid Els 2014
DHHS Tasmania 2014