Diabetes Emergencies

Treatment 2

At this stage in management of DKA the key issues are:

BG level now less than 14mmol/l - now need to add in dextrose 10%. The rate of insulin needs to be reduced in line with the Scottish DKA protocol. Insulin 'switches off' ketone production
Potassium replacement - there is always massive depletion of total body potassium and replacement needs to commence early (once serum potassium level is known) in the treatment of DKA -unless anuria suspected. Whilst initial potassium levels may be low/normal or even high in DKA, levels in the blood will fall once insulin is commenced

Top Tip: Regular monitoring of U & Es at end of hour 2 and hour 4 and BG (hours 2, 3 and 4) is essential for safe management of DKA.

Top Tip: Reference range for ketones are:

Blood ketones:

Up to 0.6 is normal.
0.6 to 1.5 is small to moderate increase.
1.5 moderate to large increase.

Urine ketones:

neg
+trace
++small
+++moderate
++++large

Case progression:

Careful monitoring of biochemistry and clinical status continue on the high dependency unit with regular review by senior members of the team.

By the morning after admission the patient is clinically well and feeling hungry. Her BG level is 8.9mmol/L and blood ketones are 0.4mmol/L and biochemistry is normal. You confirm with senior staff that it is appropriate to recommence subcutaneous insulin.