From the Guidelines
Discharge for a patient with mild diabetic ketoacidosis (DKA) should not be considered until they have received appropriate treatment and stabilization, as indicated by the most recent guidelines from 2025 1.
Key Considerations for Treatment
- Intravenous fluid resuscitation with normal saline, aiming to replace 50% of the estimated fluid deficit in the first 8-12 hours, as recommended in the 2025 guidelines 1.
- Insulin therapy, which can be initiated with 0.1 units/kg rapid-acting insulin analog as a subcutaneous bolus, followed by 0.1 units/kg/h short-acting insulin IV, or a fixed-rate IV insulin infusion, as outlined in the 2025 standards of care 1.
- Electrolyte replacement, particularly potassium, to maintain levels between 4 and 5 mmol/L, is crucial, as emphasized in both the 2004 and 2025 guidelines 1.
Criteria for Discharge
- The patient should have a glucose level below 200 mg/dL, and bicarbonate levels should improve above 18 mEq/L, as suggested by the criteria for resolution of DKA 1.
- The anion gap should normalize, and the patient should show clinical improvement, be able to tolerate oral intake, and have a clear follow-up plan with a subcutaneous insulin regimen, as recommended in the 2025 guidelines 1.
Importance of Stabilization
Even mild DKA can rapidly deteriorate and become life-threatening if not properly managed, highlighting the need for careful monitoring and treatment until the patient is stabilized, as cautioned in the 2004 study 1.
Recent Guidelines
The 2025 guidelines from Diabetes Care provide the most current recommendations for the management of DKA, including the use of IV fluids, insulin, and electrolyte replacement, and should be followed for the best patient outcomes 1.
From the Research
Discharge Considerations for Mild DKA
- Patients with mild Diabetic Ketoacidosis (DKA) may be considered for discharge if their condition is stable and they are able to manage their diabetes at home 2, 3.
- However, it is essential to ensure that the patient's blood glucose levels are under control, and they are able to recognize the signs and symptoms of DKA to prevent future episodes 4.
- The patient should also be educated on how to manage their diabetes during times of illness and how to monitor their glucose and ketone levels 3, 4.
Treatment and Management
- Treatment for DKA typically involves fluid and electrolyte replacement, insulin administration, and management of any underlying conditions that may have contributed to the development of DKA 2, 3, 4.
- In some cases, sodium bicarbonate may be used to treat severe acidosis, but its use is controversial and should be carefully considered 5, 6.
- Regular monitoring of blood glucose, electrolyte, and ketone levels is crucial to ensure that the patient's condition is improving and to make any necessary adjustments to their treatment plan 2, 3, 4.
Patient Education and Follow-up
- Patient education is critical to prevent future episodes of DKA and to ensure that the patient is able to manage their diabetes effectively 2, 3, 4.
- Patients should be instructed on how to recognize the signs and symptoms of DKA, how to monitor their glucose and ketone levels, and how to adjust their insulin doses during times of illness 3, 4.
- Follow-up appointments with a healthcare provider are essential to monitor the patient's condition and make any necessary adjustments to their treatment plan 2, 3, 4.