‘Complete initial evaluation, Check capillary glucose and serurvurine ketones to confirm hyperglycemia and ketonemia/ketonuria. Obtain blood for metabolic profil, Start lV Nuids: 1.0 L of 0.9% NaCl per hour.t WFuids Bicarbonate Instn Regular Potassium t + t 7 T mares ears? IY Route Iv Rowe Esiatisn adouata (OKA sna HHS) (OKA and HH) renal oeten (ane Determine hycaton statis [Wo] [ Toemmatla | ‘utp = £0 i) 100] | soomit.0 1 ‘20meq | [ O1 UagEmn. Severe carcoganse NGL. inuse | | as Vbotss Hypovolemia’ ag shock for3 hours 0.14 Ung Buon nt T se IV conus | | Insulin infston. ‘Ki e3.3 mEq 1 >5.2meEqL Aart 0.9% Hemodinanic Repent] | counts’ I ‘Nacl(10 UN) ‘monioing! oer acmenae pressore ares Hol ian ad ge Do not ove, pH 20-0 mEq fe bal check serum kt Evaluate coretied Ome ‘Serum Na*t ioe IF Serum glutose oes not fall by at Until f° 2 3.3mEqt. every 2 hes, TO ue feast 10% i rst hour, ge 0.14 = ‘Uskg 83 1V bolus, then continue: Serna? Serumbist- Sum \ sere ur Nat Serum Na Sera Nat ‘high orthal low DKA ¢ 3 HHS Ki=33-52mEql | When sor gens ‘When serum gene reaches 200 mgidl, reduce reaches 300 mid, reduce 048% NeCl 09% Nec euler sun eso gular inulin {es0-sd0min’) ———_(@80-S00mi) (02-0.08 Ughe W, orgie | | 002-008tskgheW Keop | Gvead a0 meqKin exch depending on ‘depending on ‘rapid-acting insulin at 0.1 ‘serum glucose between 200 liter of TY fuid fo keep serum hyration stot hydration state Uhig SC every 2 hrs. Keop ‘and 360 mgidl until patients Kr between 4:5 mEq. serum glucose beeen 150 metal alo. sd 20 rll ul eeoubon of DKA ‘When serum glucose reaches 200 mall (DKA) or 200 mata (Hts), change 0 5% donvose wih 0.48% NaCl a 150-260 me ‘Check eietrives, BUN, venous pH ereainine and gucasa every 2-4 fre unl sabia, ‘After resoluton of DKA oc HHS and when patients able o es, ate SC multidose insulin regimen, To transfer from WV to SC, continue {V Insulin infusion for 1-2 hr ator SC insulin begun to ensura adequate plasma insulin levels. In insulin natvo patellar a5 Ung 0.8 Ung body wei pr iy and jn a8 nuded,t glucose. + anion gap" t serurn/urine Ketones and/or + sdrum beta“OHB, 4 pi (venous or arterial) or 4 bicarbonate Plasma electrolytes, anion gap. gitease, creatinine, plasma osmo- fallty. fluid baiance, level of consciousness every 24h Precipitating factors (Table 1), Complications (Table 1) wawas Serum iC) Aelaosie Severe dene avo 53 pga GH) [moattate ence 22028 ancl, Om Nadi oo Nal Give 20 Gieioa0 iene ree peo ren so nean, | (macnn | | Sectet, | fossil, | [ esaih Sh, | Gee) so cotieee tae cmiaetarvcne| femttlalmmorns] | care Saintes nypseinsions Ll aso mtitexan | (Sneinsuimanea) [Eas auuresve| | nyscktcnua | | Shoe actin mea Tepes sc] | Meeaatseia® | | wees reat Sas Toate ot Uys ‘Adjust rate of insulin infusion based on anion, Corrected plasma [Na"l! Avoid hypokalemia and hypoatycernia Corrected plasma [Nal fe low: or Rate of fall oF jis normal or high: and Rate offal! of effective plasma, 1 ampoutest hypokalemia