From the Guidelines
Diabetic ketoacidosis (DKA) treatment should prioritize fluid resuscitation, insulin therapy, and electrolyte management, with a focus on individualized care based on the patient's clinical and laboratory assessment, as recommended by the most recent guidelines 1.
Key Components of DKA Treatment
- Fluid resuscitation: Aggressive intravenous fluid replacement using normal saline, with the rate adjusted based on hemodynamic status.
- Insulin therapy: Continuous intravenous insulin is the standard of care for critically ill patients, with a basal insulin dose administered 2-4 hours before stopping intravenous insulin to prevent recurrence of ketoacidosis.
- Electrolyte management: Potassium replacement is crucial, with levels maintained between 4-5 mEq/L, and bicarbonate therapy generally reserved for severe acidosis (pH < 6.9).
Monitoring and Assessment
- Glucose levels should be monitored hourly, with electrolytes and acidosis assessed every 2-4 hours.
- The underlying cause of DKA must be identified and addressed, commonly infection, medication non-compliance, or new-onset diabetes.
Recent Guidelines and Recommendations
- The American Diabetes Association recommends individualized treatment based on a careful clinical and laboratory assessment, with a focus on restoring circulatory volume, resolving hyperglycemia, and correcting electrolyte imbalance and acidosis 1.
- Recent studies have shown no significant difference in outcomes between intravenous human regular insulin and subcutaneous rapid-acting analogs for treating mild or moderate DKA, and bicarbonate therapy is generally not recommended 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. 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 medical assistance should be obtained immediately if symptoms of DKA occur 2.
From the Research
Diabetic Ketoacidosis Treatment Overview
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes that requires prompt treatment 3
- The main goals of treatment are to restore circulating volume, manage insulin therapy, replace electrolytes, and address any underlying precipitating events 3
Key Components of Treatment
- Restoration of circulating volume through intravenous fluid therapy 4
- Insulin therapy administered intravenously 4
- Electrolyte replacement, particularly potassium replacement 4
- Treatment of any underlying precipitating event 3
Important Considerations
- Early diagnosis and management are crucial to improve patient outcomes 3
- Being alert to signs of life-threatening complications such as cerebral oedema and adult respiratory distress syndrome (ARDS) is essential 4
- Near-patient testing of capillary beta-hydroxybutyrate (b-OHB) using a ketone meter can aid in managing and preventing DKA 4