Clinical Scenario

This protocol addresses metabolic acidosis arising in the context of diabetic ketoacidosis (DKA), specifically when capillary blood ketones exceed 3 mmol/L in association with hyperglycaemia — a combination that defines the clinical threshold for this condition and guides the initiation of targeted treatment.

Diagnostic Context

Capillary blood ketones above 3 mmol/L associated with hyperglycaemia constitute a recognised diagnostic criterion for diabetic ketoacidosis. Identifying this threshold is the first step toward applying the appropriate evidence-based regimen.

Treatment Approach — Partial Overview

Management involves continuous intravenous insulin, which is preferred over the subcutaneous route, administered without a preceding bolus dose. Sodium bicarbonate is generally not recommended in this setting. Correction targets encompass blood ketones, bicarbonate, and capillary blood glucose — the full dosing parameters, adjustment thresholds, and protocol sequence are available in the complete regimen below.

References

DOI: 10.1053/j.ajkd.2019.01.036

Depending on the various cut-offs reported, blood ketones above 3 mmol/L associated with hyperglycemia constitute a good diagnostic criterion of diabetic ketoacidosis.
Insulin should probably be administered intravenously rather than subcutaneously in patients with diabetic ketoacidosis (GRADE 2+, STRONG AGREEMENT).
An insulin bolus should probably not be administered before starting continuous intravenous insulin therapy in patients with diabetic ketoacidosis (GRADE 2−, STRONG AGREEMENT).
Low continuous intravenous insulin doses should probably be administered in the treatment of diabetic ketoacidosis (GRADE 2+, STRONG AGREEMENT).
Sodium bicarbonate should probably not be administered to patients with diabetic ketoacidosis (GRADE 2−, STRONG AGREEMENT).

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Treatment of Metabolic Acidosis in Diabetic Ketoacidosis with Capillary Blood Ketones Above 3 mmol/L

References