DKA

Question 1

What is this a presentation of?

Drowsiness, vomiting, dehydration, abdominal pain in a type 1 diabetic.

Answer 1

Diabetic Ketoacidosis

Question 2

How is diabetic ketoacidosis diagnosed?

Answer 2

1. Acidaemia (pH <7.3)
2. Hyperglycaemia (>11) or known diabetes mellitus
3. Ketonaemia (>3) or 2+ on dipstick

Question 3

What is the management of a diabetic ketoacidosis?

Answer 3

1. IV saline
2. Insulin infusion at 0.1U/kg/hr
3. Aim for fall in ketones 0.5/hr or CBG 3/hr or bicarbonate rise of 3/hr
4. Avoid hypoglycaemia, add 100ml/hr 10% dextrose when CBG <14
5. Continue insulin until ketones <0.6/pH >7.3/bicarbonate >15
6. Add potassium after first bag guided by VBG
7. Do not stop insulin guided by glucose, guide by ketones.