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[IP] Re: DKA Treatment

Here's the standard tx for DKA (not for the various complications which can 
it is taken from Griffith's 5 Minute Clinical Consult:

1. Monitor ABC's (airway, breathing, and circulation)
2. Monitor EKG for electrolyte induced cardiac changes
3. Provide replacement fluids by do not aggressively rehydrate due to 
inability to accurrately assess dehydration status due to effects of osmotic 
diuresis.  (IV's = Normal Saline)
4. Replace lost electrolytes (Na, Cl, K)
5. Acidosis usually corrects self with administration of insulin, however in 
severe cases (pH < 7.1) bicarbonate should be considered.
6. Provide Insulin, via IV since subcutaneous routes are suboptimal.  This 
not only lowers BG but terminates the production of Ketones and associated 
acids.  The aim is to lower BG by 50 to 100 mg / dl / hr.  
7.  Provide glucose when blood level drops to roughly 300 mg / dl.  When BG 
reaches 200 mg / dl, switch IVs to 10% dextrose.
8.  Stop infusions when pH > 7.3, HCO3 (bicarbonate) >15, glucose < 300, and 
patient is tolerating oral fluids.  Convert to subQ insulin and discharge.

Obviously, in there they are also going to try to determine the cause of the 
DKA -- infection, pump malfunction, patient non compliance with therapy (I 
know this is going to annoy someone...but facts are that it does happen in 
some patients).

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