Treatment of Diabetic Ketoacidosis: First-Line Clinical Protocol
Diabetic ketoacidosis (DKA) is an acute metabolic emergency requiring prompt, structured intervention to correct the underlying metabolic disturbance and achieve measurable resolution targets.
Clinical Approach
First-line management centres on intravenous fluid resuscitation with 0.9% sodium chloride solution and a fixed-rate intravenous insulin infusion (FRIII), with careful attention to potassium balance throughout — the complete sequenced protocol is available via the link below.
Treatment Goals
- Reduce blood ketone concentration by at least 0.5 mmol/L per hour
- Increase venous bicarbonate by 3.0 mmol/L per hour
- Reduce capillary blood glucose by 3.0 mmol/L per hour
- Maintain potassium between 4.0 and 5.5 mmol/L
- Resolution: blood ketones <0.6 mmol/L and venous pH >7.3 — typically achieved within 24 hours
References
- Commence 0.9% sodium chloride solution (use a large bore cannula) via an infusion pump
- Start a continuous FRIII via an infusion pump. This is made of 50 units of human soluble insulin (Actrapid®, Humulin S®) made up to 50 ml with 0.9% sodium chloride solution.
- Thus it is recommended that 0.9% sodium chloride solution with potassium 40 mmol/L (ready-mixed) is prescribed as long as the serum potassium level is below 5.5 mmol/L and the person is passing urine.
- Reduction of the blood ketone concentration by 0.5 mmol/L/hour
- Increase the venous bicarbonate by 3.0 mmol/L/hour
- Reduce capillary blood glucose by 3.0 mmol/L/hour
- Maintain potassium between 4.0 and 5.5 mmol/L
- Resolution of DKA is defined as ketones less than 0.6 mmol/L and venous pH over 7.3
- By 24 hours the ketonaemia and acidosis should have resolved in most people
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