Podcast # 421: Sweet DKA Pearls

Author: Gretchen Hinson, MD

Educational Pearls:

• Diabetic ketoacidosis patients are subject to electrolyte derangements
• Potassium should be monitored closely:
  
  • K < 3.3 = Do not give insulin and replete K first
  • 3.3 < K < 5.3 = give 20-30mEq K for each L of IVF 
  • K > 5.3 = delay potassium replacement
• Adult patients are typically severely volume depleted and can require 50 cc/kg bolus or more
• Insulin typically given in bolus of 0.1 units/kg followed by drip at 0.1 units/kg/hr

References:

Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. Review. PubMed PMID: 28372715.

Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management.Metabolism. 2016 Apr;65(4):507-21. doi: 10.1016/j.metabol.2015.12.007. Epub 2015 Dec 19. Review. PubMed PMID: 26975543.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD