DKA management

ACTION 1

• ABCDE (including IV fluid replacement)
• assess dehydration (HR, BP)
• take age, gender and concomitant medication into account
• if SBP <90, give 500mL bolus normal saline over 10-15mins (can repeat if SBP remains <90 while awaiting senior input)
• monitor K levels (may be high on admission but drops with insulin Rx) and give replacement if falls below 5.5

ACTION 2

• start continuous fixed rate IV insulin infusion at 0.1unit/kg/hr
• priming dose not needed if started promptly
• if there is a delay, give IM stat dose (0.1unit/kg)
• continue normal dose and timing of long-acting insulin

ACTION 3

• clinical assessment: RR, temp, BP, HR, SaO2, GCS, full Ex
• continuous cardiac monitoring
• continuous pulse oximetry
• consider precipitating causes and treat appropriately 
• establish usual meds for…