Red flags
- pH <7.0 → HDU/ICU
- K+ <3.5 — hold insulin
- GCS drop
- Suspected sepsis or MI trigger
First steps
- ABCDE + IV access
- Glucose, ketones, VBG, U&E
- 1 L NS over 1 h
Key investigations
- Ketones, glucose, VBG
- U&E, CBC, blood/urine cultures, CXR
- ECG, troponin, amylase
Differentials
- HHS (glucose >30, no ketones, hyperosmolar)
- Alcoholic ketoacidosis
- Salicylate poisoning
Initial management
- Insulin 0.1 U/kg/h fixed-rate (continue basal SC)
- Add K+ 40 mmol/L when K 3.5-5.5
- Add 10% dextrose when glucose <14 mmol/L
- Resolution: ketones <0.6, pH ≥7.3, HCO3 ≥18
Referral
- Diabetes specialist for post-resolution SC insulin plan
AI clinical assessment
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