Ketoacidosis is more common in type 1 diabetes than in type 2. The goal treatment is to stop ketosis, not to normalize glucose.
Common symptoms: polyuria, polydipsia, vomiting, dehydration, weakness, altered mental status, coma, abdominal pain, Kussmaul respirations, tachycardia, hyponatremia, hyperkalemia
Treatment:
- Fluid replacement: start with 0.45-0.9% NS, change to 5% dextrose or dextrose containing saline when glucose is less than 200 mg/dl.
- Correct serum sodium(for every 100mg/dL increase over 100 in glucose, increase sodium by 1.6). Usually, 0.9% NS, do not rapidly correct sodium ever.
- If potassium is less 3.3 mEq/L, replace KCl before giving insulin.
- Insulin: 0.1 unit/kg bolus and then infusion ONLY if KCl is greater than 3.3 mEq/L. Keep glucose 150-200 mg/dl until DKA resolves.
- If pH <= 6.9 – Give bicarb over 1-2 hours
- DKA is resolved when serum glucose is less than 200 and 2 of the following:
Venous pH > 7.3
Bicarb 15 mEq or greater
Anion gap of 12 mEq or less
If you prefer charts, here’s one I downloaded for my notes.
