Triad: hyperglycaemia (>11 mmol/L or known DM), ketonaemia (≥3), acidosis (pH <7.3 or HCO3 <15).
Causes
- • Infection (30%)
- • Missed insulin
- • New-onset T1DM
- • MI, pancreatitis, drugs (SGLT2i euglycaemic DKA)
Investigations
- • Glucose, ketones, VBG, U&E, CBC
- • ECG, blood/urine culture, CXR, amylase
Management
- • Fluids: 1 L NS over 1 h, then 1 L over 2 h × 2, then 4 h × 2, then 6 h
- • Insulin: 0.1 U/kg/h fixed-rate IV (continue basal SC insulin)
- • K+: add 40 mmol/L if K 3.5-5.5; hold insulin if K <3.5
- • Add 10% dextrose when glucose <14 mmol/L
- • Resolve when ketones <0.6, pH ≥7.3, HCO3 ≥18
Complications
- • Cerebral oedema (children)
- • Hypokalaemia
- • VTE
- • Aspiration
References
- • JBDS 2023 DKA
Related in WardRound
Educational — verify locally.
