Diabetic Ketoacidosis (DKA)

The blood sugar is NOT the emergency- Acidosis, Hypokalemia, and Dehydration are!!!











Signs and Symptoms











* Vomiting* Abdominal pain* Polydipsia* Polyuria











Step 1: Test for DIABETIC-KETO-ACIDOSIS











* Diabetes* Blood sugar* Typically notably elevated (>250 mg/dL)* Can be normal in certain circumstances* Ketones* Easiest test is a urinalysis* Serum ketones also can be obtained* Acidosis* Blood gas (arterial or venous)* pH <7.3











Step 2: Check Potassium Level











* Patients frequently depleted of whole body potassium* Insulin administration will causes further drops in serum potassium level











Step 3: Replace Potassium











* If potassium <3.3, do not give insulin* Replace potassium prior to insulin* If potassium >3.3 but <5.5* Consider supplementing potassium at this point* May continue insulin











Step 4: Give Fluids











* Adult patients are frequently 3-6 LITERS depleted* 20 ml/kg NS during first hour











Step 5: Start an Insulin Drip











* This accomplishes 2 things…* It decreases blood sugar* It also decreases acid production











Additional Reading











* Peds H- Hyperglycemia and Hypoglycemia (EM Clerkship)* DKA Myths (REBEL EM)