This protocol applies to a patient with type 1 diabetes presenting in diabetic ketoacidosis with dehydration exceeding 5%, who is haemodynamically stable (not in shock), showing active metabolic acidosis with hyperventilation, and vomiting — when the initial management approach has not reached its intended endpoints.
Diabetic ketoacidosis • Dehydration >5% • Not in shock • Acidosis (hyperventilation) • Vomiting
The initial line of management — intravenous fluid therapy combined with a continuous intravenous insulin infusion — has not achieved its targets: pH has not normalised, ketones have not cleared, blood glucose has not fallen to the expected threshold, and the patient is not yet tolerating oral intake. This protocol represents the structured next step.
At this escalation point, management addresses cerebral edema as a recognised complication, involving an osmotherapy approach alongside deliberate adjustment of intravenous fluid volumes. The full protocol specifies agent selection and the complete stepwise algorithm.
DOI: 10.1016/j.jcjd.2017.10.036