Adult Monitoring and
Assessment in DKA

 

Patient Monitoring - Consider Early Referral to Endocrinologist or Internal Medicine

  • Stat Chemstrip and Urine initially
     
  • Lytes, glucolse, BUN, Creatine, CBC, Urinalysis and ECG stat
     
  • Chemstrip hourly X 12 hours then q2h. Call MD with results
     
  • Lytes hourly X 4, then q2h X 8h, then q4h until stable
     
  • Blood gases q4h X 16 hour ___Venous; ___ Arterial
     
  • Foley cather
     
  • Search for precipitating cause of DKA (i.e. infection, non-adherence to insulin)
     
  • Cosnider ICU admission

 

Calculations

  • Corrected Serum Na: For every 5.0mmol/L elevation in glucose above normal, there is a 1.5 mmol/L depression of uncorrected Na
  • Osmolality: 2Na + glucose = BUN = osmolality; Normal = 281 - 297 mmol/Kg

 

SC Insulin Schedules (Start when patient drinking/eating well)

1 - Resume former insulin schedule
OR
2 - Washington Manual suggests
1/2 1U/Kg/day divided 4 times a day of regular insulin
OR
3 - Mixture of Intermediate or Short-acting Insulin
  Intermediate insulin:
  • 10-15U before breakfast
  • 8 - 12U before supper

Short-acting Insulin as a sliding scale. Overweight patients often need higher insulin doses

OR
Discuss with Endocrinologist or Internal Medicine

 

- Maureen Allen

Thanks to Dr. Leo Pereira, Deptartment of Internal Medicine, St. Martha's Regional Hospital in Antigonish Nova Scotia for reviewing the draft copy of this article.

You can search for abstracts of the above references by following this link: PubMed

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