Diabetic Ketoacidosis in adults: Part 2. Management
The priorities for the management of Diabetic Ketoacidosis (DKA) are to assess severity and establish intravenous (i.v.) 0.9% NaCl rehydration with the careful addition of potassium ([K+]). Ideally, a fixed rate insulin infusion should be used initially and addition of 10% glucose infusion when the blood glucose level has fallen to below 14 mmol/l. Regular clinical and laboratory monitoring, particularly of the rate of fall of blood ketones (beta-hydroxybutyrate) and of serum [K+] and glucose is essential to guide fluid and insulin infusion rates. When the criteria for resolution of DKA are met, the patient may be switched to subcutaneous (s.c.) insulin if eating or variable rate insulin infusion if not yet able to eat and drink. Basal insulin should be continued (or started) where possible alongside infused insulin during the treatment of DKA. If fixed rate insulin infusion is not possible, then intermittent s.c. insulin injections may be used instead.