DKA – Diabetic Ketoacidosis 💉

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🧠 Definition & Criteria

  • Glucose >13.8 mmol/L + ketones >3 mmol/L (or ++ on dipstick)
  • pH <7.3 or HCO₃⁻ <18 mmol/L, anion gap >10
  • ⚠️ Refer to local guidelines for specific management protocols ⚠️

📞 What to Ask / Orders to Make

  • Capillary glucose + blood ketones
  • Venous/arterial blood gas (pH, HCO₃⁻, lactate)
  • U&E, FBC, CRP; submit septic screen if unwell
  • Insert 2 × IVs, urinary catheter, consider CVP
  • Call senior/endocrine early — ICU if severe

🧾 Initial Assessment

  • ABCs — airway, breathing, circulation
  • Vitals + GCS; assess hydration (CRT, turgor)
  • Look for infection, MI, pancreatitis as triggers

💧 Fluid Resuscitation

  • 0.9% NaCl: 1 L/hr ×1 hr → 1 L/2 hr → 1 L/4 hr → 1 L/8 hr
  • Switch to 5% dextrose once glucose <12 mmol/L
  • Avoid rapid glucose drop — target reduction of 3–5 mmol/L/hr

⚡ Potassium Replacement

  • Do not add K⁺ until urine output confirmed
  • >5.0: none; 3.5–5.0: +20 mmol/L; <3.5: +40 mmol/L
  • Monitor serum K⁺ every 2–4 hrs; ECG if deranged

💉 Insulin Infusion

  • Start 0.1 U/kg/hr regular insulin IV after fluids started
  • Titrate per glucose: 0–4: 0, 4–10: 0.5 U/hr, … >20: call senior
  • Add dextrose when glucose <12 mmol/L; don’t stop insulin

🧪 Ongoing Monitoring

  • Hourly glucose + ketones
  • VBG q2–4 hrs, U&E, K⁺ with matching frequency
  • Watch for cerebral oedema: headache, ↓GCS, bradycardia

🔍 Investigations

  • ABG/VBG, U&E, FBC, CRP
  • Blood & urine cultures if suspect infection
  • CXR/ECG if respiratory/MI signs or sepsis

📌 Escalation

  • ICU if pH <6.9, hypotensive, ↓GCS, K⁺ deranged
  • Overlap SC insulin with IV infusion (~30 min) once eating
  • Identify and treat underlying cause (infection, omission)
  • Endocrine/ICU referral early

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:40

ATRP re: diabetic ketoacidosis (DKA)
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [type 1 diabetes, insulin compliance]

🧾 Hx:
• Symptoms: polyuria, polydipsia, vomiting, abdominal pain
• Duration and precipitating factors (infection, insulin omission)
• Previous DKA episodes

🩺 Exam:
• Vitals: HR __ BP __ RR __ Temp __ SpO₂ __
• Signs of dehydration, Kussmaul breathing
• Mental status and GCS

📋 Impression:
DKA with metabolic acidosis and ketosis

📌 Plan:
• ABCDE assessment and oxygen as needed
• IV fluids: 0.9% saline bolus then maintenance
• IV insulin infusion
• Monitor blood glucose, ketones, electrolytes hourly
• Correct electrolytes, especially potassium
• Identify and treat precipitating cause
• Frequent clinical and biochemical monitoring

👤 [Your Name], [Role]
IMC: _______
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