DKA – Adult

Things to remember

  • Give 0.9%NaCl
  • Actrapid “Fixed Rate” 0.1unit/kg/hr
  • Basal Insulin (lantus/levemir) give this too – usual time and dose
  • Potassium – if below 5.5 will need KCl infusion (see guide)
  • BM <14 – Start 10% Dextrose 125ml/hr

Criteria:

  1. Blood ketones ≥ 2 mmol / L or Ketonuria ≥ 2+ on standard blood & urine sticks respectively.
  2. BM > 11 mmol/L or known Type 1 Diabetes
  3. Venous bicarbonate ≤ 18 mmol and / or pH < 7.3

Tests:

  • Blood: FBC, U&E, LFTs, VBG, plasma glucose, blood cultures (only if septic and febrile)
  • ECG
  • CXR
  • Urinalysis (for infection screen and for ketones)

Fluid:

Adult patients may require  significant amounts of fluid

  • Bag 1 –  0.9% NaCl 1000ml 1hr
  • Bag 2 – 0.9% NaCl 1000ml 2hr
  • Bag 3 – 0.9% NaCl 1000ml + 20mmol KCl 4hr
  • (further bags see PDF)

Potassium:

Potassium levels will likely drop significantly with insulin therapy so we need to consider KCl infusion. In the initial stages it is safer to use  a separate bag through a second cannula (due to fluid flow rates)

  • [K] <3.5 – Senior Review
  • [K] 3.5 – 5.5 –  0.9%NaCl + 40mmol KCL 4hr
  • [K] >5.5 – Nil required

Insulin:

  • Add 50unit Actrapid insulin to 49.5ml 0.9%NaCl
  • Run @ 0.1unit/kg/hr [i.e 60kg adult – 6ml/hr]
  • Levemir or Lantus, continue this at usual dose and times
  • Not improving contact Med Reg

BM ≤ 14 mmol/l

  • Start 10% dextrose @ 125ml/hr
  • Contact Med Reg

Full PDF:DKA-Adult

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