What is the treatment for Diabetic Ketoacidosis (DKA)?

From the Guidelines

Diabetic ketoacidosis (DKA) treatment requires prompt intervention with intravenous fluids, insulin therapy, and electrolyte replacement, with the primary goal of restoring circulatory volume, resolving ketoacidosis, and correcting electrolyte imbalance and acidosis, as recommended by the most recent guidelines 1.

Key Components of DKA Treatment

• Aggressive fluid resuscitation using normal saline at 15-20 mL/kg in the first hour, then continuing at 250-500 mL/hr until hydration is restored
• Insulin therapy, typically starting with an infusion at 0.1 units/kg/hr after initial fluid bolus, avoiding insulin boluses which can cause hypoglycemia
• Electrolyte replacement, particularly potassium, when levels are below 5.3 mEq/L, typically with 20-30 mEq/L in IV fluids
• Monitoring of blood glucose, electrolytes, and ketones every 2-4 hours
• Identification and treatment of the precipitating cause of DKA, which may include infection, medication non-compliance, or acute illness

Transition to Subcutaneous Insulin

• Transition to subcutaneous insulin only when the patient is metabolically stable, able to eat, and ketoacidosis has resolved, typically with overlapping IV insulin for 1-2 hours after the first subcutaneous dose, as supported by recent studies 1

Use of Bicarbonate

• Bicarbonate therapy is generally not recommended, except in severe cases with pH <6.9, as its use has been shown to make no difference in the resolution of acidosis or time to discharge 1

Individualization of Treatment

• Treatment should be individualized based on a careful clinical and laboratory assessment, taking into account the patient's specific needs and circumstances, as emphasized by recent guidelines 1

From the FDA Drug Label

Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death. Therefore, it is important that you obtain medical assistance immediately.

The treatment for Diabetic Ketoacidosis (DKA) is not explicitly stated in the provided text, but it is mentioned that patients should obtain medical assistance immediately if they experience symptoms of DKA 2.

From the Research

Treatment Overview

The treatment for Diabetic Ketoacidosis (DKA) involves several key components, including:

• Fluid and electrolyte replacement to restore normal hemodynamic status and decrease metabolic acidosis 3, 4, 5, 6, 7
• Insulin administration to decrease glucose concentrations and metabolic acidosis 3, 4, 5, 6, 7
• Treatment of precipitating causes and close monitoring to adjust therapy and identify complications 5

Fluid Replacement

Fluid replacement is a crucial aspect of DKA treatment, with the following recommendations:

• Initial replacement fluid: isotonic saline at 500 ml/hr to replace extracellular fluids 3
• Subsequent replacement fluid: 2 to 4 L of 5% glucose in 0.45% saline with potassium chloride and/or potassium phosphate to replace intracellular fluids at 250 ml/hr 3
• 5 percent glucose in 0.45 percent saline plus 40 mEq of potassium chloride or buffered potassium phosphate, given at a rate of 250 mL per hour 7

Insulin Administration

Insulin administration is also critical in DKA treatment, with the following guidelines:

• Initial rate: 0.1 u per kg per hour by intravenous drip 7
• Low-dose intravenous insulin 3
• Titration of insulin therapy against the change in blood glucose concentration 6

Monitoring and Laboratory Tests

Regular monitoring and laboratory tests are essential to prevent complications and adjust therapy, including:

• Serum glucose and potassium measurements every 2 to 3 hours 3
• Bicarbonate, sodium, and chloride measurements every 4 to 6 hours 3
• Electrolytes, phosphate, blood urea nitrogen, creatinine, urinalysis, complete blood cell count with differential, A1C, and electrocardiography evaluations 5
• Arterial blood gas measurements and serum ketone levels only when indicated, and not routinely 3, 7