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)