MANAGEMENT OF

HISTORY
DKA
Polyuria, Polydipsia,
Weight loss, abdominal
pain, vomiting,
confusion

CLINICAL SIGNS
Dehydration, Deep sighing
respiration, fruity odor,
lethargy/ drowsiness.

BIOCHEMICAL
FINDINGS
Blood
glucose>200mg/dl,
pH <7.3,

DIAGNOSIS OF
DKA
SHOCK/COMA
RESUSCITATION( Airw
ay, Breathing,
Circulation-0.9%
saline 10-20 ml/kg
over 1-2 hr, not to
exceed 30 ml/kg

DEHYDRATION
&ACIDOSIS
IV Therapy(deficit
+24 hr maintenance)
to be corrected over
24-48 hrs initially
with isotonic saline
and later with N/2
saline. Add KCl @ 40

MINIMAL
DEHYDRATION +
ORALLY ACCEPTING
Start with SC Insulin
and continue oral
No

CONTIUOUS INSULIN INFUSION @ 0.1 U/kg/hr

MONITORING
Blood Glucose, Input/output Chart & Neurological status to be monitored
hourly
Monitor electrolytes 2 hourly

ACIDOSIS NOT
IMPROVING
Re evaluate IV
Calculations, Check
insulin delivery system
& dose.Consider sepsis.

If blood glucose <250

mg/dl or fall by >
90mg/dl, change fluid
to N/2 saline with 5%
dextrose( Adjust Na).
If improves shift to
SC insulin then stop
insulin infusion after

NEUROLOGICAL
DETERIORATION R/O
Hypoglycemia
Suspect Cerebral edema :
Give mannitol @ 0.5-1
g/kg, restrict IV fluids by
one third . Move to ICU and
consider hyperventilation.
Consider cranial imaging