From the Guidelines
Admitting criteria to the Intensive Care Unit (ICU) for Diabetic Ketoacidosis (DKA) include severe metabolic acidosis, significant ketonuria or ketonemia, and high blood glucose levels.
Key Criteria
- Blood glucose level: 250 mg/dl or higher 1
- Arterial pH: 7.30 or lower 1 or venous pH: 7.3 or lower 1
- Serum bicarbonate level: 15 mEq/l or lower 1
- Ketonuria or ketonemia: moderate to severe 1
Additional Considerations
- Patients with altered mental status, severe dehydration, or cardiovascular instability may also require ICU admission 1
- Moderate to severe electrolyte imbalances, such as hypokalemia or hyperkalemia, may also necessitate ICU admission 1
Management
- Intravenous insulin therapy and fluid replacement are crucial in managing DKA 1
- Monitoring of serum electrolytes, glucose, and venous pH is essential to assess response to therapy 1
From the Research
Admitting Criteria to the Intensive Care Unit (ICU) for Diabetic Ketoacidosis (DKA)
The following are the admitting criteria to the ICU for DKA:
- Severity of acidosis, as indicated by pH and bicarbonate levels 2
- Glasgow Coma Scale (GCS) score, with lower scores indicating a higher need for ICU admission 2
- Presence of comorbidities, such as COVID-19 infection or non-ST-elevation myocardial infarction (NSTEMI) 3
- Age, with older patients being more likely to require ICU admission 3
- Body mass index (BMI), with higher BMIs being associated with a higher need for ICU admission 3
- White blood cell count, urea, creatinine, and C-reactive protein levels, which can indicate the severity of the condition 3
- Anion gap, which can indicate the severity of acidosis 3, 4
- Presence of complications, such as hypokalemia or treatment-induced hypokalemia 5, 4
Predictive Models for ICU Admission
Several studies have developed predictive models for ICU admission in DKA patients, including:
- A model that includes GCS, pH, bilirubin, bicarbonate, and pH-bicarbonate interaction 2
- A model that includes age, Asian ethnicity, concurrent COVID-19 infection, DKA severity, DKA trigger, and NSTEMI 3
Standardized Care Pathways
Implementing standardized care pathways for DKA management can reduce ICU admissions and improve patient outcomes, as shown in a study that used a subcutaneous insulin-based pathway 4