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Diabetic Ketoacidosis Treatment:
- At least at our academic medical center, we find it very hard to get a DKA patient admitted to an ICU or IMC while they are still in DKA. Typically, we can correct the acidosis and downgrade them to a floor bed before their ICU/IMC bed is available.
- Some key points to remember when managing DKA in the ED.
- The mainstay of treatment for the hyperglycemia initially is IV fluids.
- Check labs often and replete Magnesium and Potassium early.
- Insulin should not be started until the potassium is confirmed to be >3.3 mEq/L
- Patients can still be in DKA even though there glucose is normal.
- Intravenous insulin must be continued until all the ketones are cleared.
- Add D5W or D10 if needed to ensure that their glucose levels stay up but do not stop the insulin.
- Patients need to receive a long acting insulin (i.e.: Lantus or NPH) 2 hours before the insulin drip is stopped. Placing a patient only on Sliding Scale Insulin will almost guarantee that they go back into DKA on the floor.
- Typically you can just restart the patients home long acting insulin, but if you are leary about hypoglycemia if they are not eating well, then give them 3/4 their home dose.
References
Charfen MA, Fernadez-Frackelton M. Diabetic Ketoacidosis. EMCNA 2005:609-628.