Diabetic Ketoacidosis (DKA)
Summary: <br> The blood sugar is NOT the emergency- Acidosis, Hypokalemia, and Dehydration are!!! <br> <br> <br> <br> Signs and Symptoms<br> <br> <br> <br> * Vomiting* Abdominal pain* Polydipsia* Polyuria<br> <br> <br> <br> Step 1: Test for DIABETIC-KETO-ACIDOSIS<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 2: Check Potassium Level<br> <br> <br> <br> * Patients frequently depleted of whole body potassium* Insulin administration will causes further drops in serum potassium level<br> <br> <br> <br> Step 3: Replace Potassium<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 4: Give Fluids<br> <br> <br> <br> * Adult patients are frequently 3-6 LITERS depleted* 20 ml/kg NS during first hour<br> <br> <br> <br> Step 5: Start an Insulin Drip<br> <br> <br> <br> * This accomplishes 2 things…* It decreases blood sugar* It also decreases acid production<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Peds H- Hyperglycemia and Hypoglycemia <a href="http://www.emclerkship.com/peds-h-hyperglycemia-and-hypoglycemia/">(EM Clerkship)</a>* DKA Myths <a href="https://rebelem.com/diabetic-ketoacidosis-dka-myths/">(REBEL EM)</a><br>
