This protocol addresses patients with type 1 diabetes in diabetic ketoacidosis (DKA) who present with shock (reduced peripheral pulses), reduced consciousness, or coma — and in whom the initial treatment line has not achieved its targets.
The patient has type 1 diabetes in DKA with one or more severe features: shock with reduced peripheral pulses, reduced consciousness, or coma. These findings signal a high-risk presentation that requires escalation beyond the initial DKA management approach.
The preceding step involved intravenous fluid therapy and a continuous intravenous insulin infusion. The targets for that line — normalisation of blood pH, clearance of ketones, reduction of blood glucose to target, and the patient being clinically well and tolerating oral fluids — have not been met. This protocol defines the step taken next.
This step addresses a specific complication that can arise in the setting of severe DKA. Management targets cerebral edema through specific agents and adjustments to intravenous fluid delivery. Full agent selection, the complete regimen, and the step-by-step sequence are available in the structured protocol.
DOI: 10.1016/j.jcjd.2017.10.036