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
- BEWARE SGLT-2 inhibitors chance of Euglycaemic DKA
Criteria:
- Blood ketones ≥ 2 mmol / L or Ketonuria ≥ 2+ on standard blood & urine sticks respectively.
- BM > 11 mmol/L or known Type 1 Diabetes
- BEWARE SGLT-2 inhibitors increased chance of Euglycaemic DKA (Dapagliflozin/Forxiga®, Canagliflozin/Invokana®, Empagliflozin/Jardiance®, Ertugliflozin/Steglatro®)
- 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