https://tgldcdp-tg-org-au.eu1.proxy.openathens.net/viewTopic?etgAccess=true&guidelinePage=Diabetes&topicfile=diabetic-ketoacidosis

• [x] eTG
• [x] litfl
• 🍒What is the diagnostic criteria of diabetic ketoacidosis?
• 🍒What are the common precipitants of diabetic ketoacdosis?
• 🍒Diabetic ketoacidosis may be seen in patients with Diabetes Mellitus Type 2 particularly pateints taking SGLT2-inhibtiors
• History
  • dry, abdominal pain, polyuria, weight loss, coma
  • risk factors: non-compliance, illness, newly diagnosed
  • ROS to rule find out possible precipitant (infection, MI, pneumonia, GI illness)
  • normal insulin regime
  • diabetic control
  • previous DKA / admissions
  • previous ICU admissions
• Examination
  • volume assessment
  • signs of cause e.g. (infection)
  • GCS
  • work of breathing
• Investigations
  • ABG
  • electrolytes
  • osmolality
  • urinalysis: ketones
  • pregnancy test
  • standard investigations to rule out cause: FBC, ECG, CXR
• Management
  • start insulin infusion (avoid bolus) 0.1u/kg/hr
  • aim to lower glucose by 1-2mmol/L/hr
  • balanced salt solution fluid resuscitation
  • once glucose <15mmol/L → provide dextrose (5%) 100mL/hr
  • monitor urinary ketones or BE clearance
  • correct osmolality by 3mosmol/kg/hr
  • K+ may be normal but patient will have a whole body K+ deficiency → needs to be replaced once <5mmol/L → use KH2PO4
  • 🍒What is the management of diabetic ketoacidosis?