DKA: diabetic ketoacidosis; IV: intravenous; NaCl: sodium chloride; SC: subcutaneous; Na: sodium; NaHCO3: sodium bicarbonate; H2O: water; KCl: potassium chloride; HCO3: bicarbonate; K: potassium; BUN: blood urea nitrogen.
* After history and physical examination, obtain capillary glucose and serum or urine ketones. Begin 1 L of 0.9% NaCl over 1 hour, and draw arterial blood gas (or mixed venous blood gas), complete blood count with differential, urinalysis, serum glucose, BUN, electrolytes, chemistry profile, and creatinine levels STAT. Obtain electrocardiogram and, if needed, chest radiograph and specimens for bacterial cultures.
¶ If initial serum K is <3.3 mEq/L, hold insulin and give KCl until K is >3.3 mEq/L.
Δ Serum Na+ should be corrected for hyperglycemia (for each 100 mg/dL glucose >100 mg/dL, add 2 mEq to sodium value for corrected serum sodium value).
◊ 100 mmol NaHCO3 = 100 mEq NaHCO3.
§ An alternative IV insulin regimen is to give a continuous IV infusion of regular insulin at 0.14 units/kg/hour; at this dose, an initial IV bolus is not necessary.
¥ Please refer to the UpToDate topic on DKA for the definition of DKA resolution.
‡ This is an UpToDate clinical suggestion.Copyright © 2006 American Diabetes Association. From Diabetes Care Vol 29, 2006; 2018-2022. Reprinted with permission from The American Diabetes Association.
Adapted and updated with additional information from: