From the Guidelines
The management of Diabetic Ketoacidosis (DKA) symptoms in the Emergency Room (ER) for a 38-year-old female involves restoration of circulatory volume and tissue perfusion, resolution of ketoacidosis, and correction of electrolyte imbalance and acidosis.
Management Goals
- Restoration of circulatory volume and tissue perfusion
- Resolution of ketoacidosis
- Correction of electrolyte imbalance and acidosis
- Treatment of any correctable underlying cause of DKA, such as sepsis, myocardial infarction, or stroke 1
Treatment Approach
- Continuous intravenous insulin is the standard of care for critically ill and mentally obtunded individuals with DKA or hyperosmolar hyperglycemia 1
- Subcutaneous rapid-acting insulin analogs may be used for patients with uncomplicated DKA, in combination with aggressive fluid management, and is a safer and more cost-effective approach than treatment with intravenous insulin 1
- Basal insulin should be administered 2-4 hours before stopping intravenous insulin to prevent recurrence of ketoacidosis and rebound hyperglycemia 1
Additional Considerations
- Adequate fluid replacement and frequent bedside testing are essential for patients treated with subcutaneous insulin 1
- Bicarbonate use is generally not recommended, as it has been shown to make no difference in the resolution of acidosis or time to discharge 1
From the Research
Management of Diabetic Ketoacidosis (DKA) Symptoms
The management of DKA symptoms in the Emergency Room (ER) for a 38-year-old female involves several key components, including:
- Reversing metabolic derangements, correcting volume depletion, electrolyte imbalances, and acidosis while concurrently treating the precipitating illness 2
- Aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event along with frequent monitoring of the patient's clinical and laboratory states 3
- Intensive laboratory workup, meticulous monitoring of insulin, and fluid management 4
- Restoration of circulating volume, insulin therapy, electrolyte replacement, and treatment of any underlying precipitating event 5
Special Considerations
In special populations, such as those with chronic kidney disease, pregnancy, or those prescribed sodium-glucose cotransporter inhibitors, the management of DKA may differ from the usual patient with diabetes 6
- Clinicians need to recognize and manage euglycaemic DKA in patients prescribed sodium-glucose cotransporter inhibitors 6
- Data on management of DKA in special populations are sparse, and recommendations are based mainly on small case series and expert opinion 6
Key Components of DKA Management
The key components of DKA management include:
- Correction of metabolic abnormalities with intravenous fluids, insulin, and electrolyte replacement 2, 3, 5
- Frequent monitoring of the patient's clinical and laboratory findings 2, 3, 4
- Identification and treatment of the precipitating condition 2, 3, 5
- Patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers to prevent recurrence of DKA 3