Bicarbona

te

IV fluids
Determine hydration
status

pH 5,9-7,0 or pH <6,9

Soluble
insulin
pH 7,0

serum
Severe
hypovolemia

Mild
Dehydration

Shock

100 mmol

plus 10 mEq KCLplus 20 mEq KCL

in 200 ml water in 200 ml water
administer in 1 hadminister in 2 h
Administer
0,9% NaCl (1
L/h)

No

<3,3 mEq/L

0,1 IU/kg/h as
continuous
insulin infusion

Hold insulin and

give 20-30 mEq/h
KCL until

Repeat every 2 h
until pH 7,0
Monitor serum

Administer 0,9% NaCl 250-500 ml/n

Depending on hydration status

Establish
adequate renal
function (urine
output ~ 50 ml/h

0,1 IU/kg
bolus IV

<5 mEq/L
50 mmol

Kemodyami
monitoring
Admister 0,9%
NaCl (1/L/h)
+ colloids

Potassium

every 2 h

>3,3

mEq/L
f serum glucose doesnt fall
by at least 10% in first hour,
the insulin dose should be
doubled or increased by 0,050,1 IU/kg (usually 1-2 IU)
every 1-2 hours

> 5,2mEq/L

Dont give
check serum
every 2 h

= 3,3-5,2 mEq/ L
Give 20-30 mEq in
each liter of IV fluid to

keep serum
When serum glucose reaches 250
mg/dl,
reduce
250
mg/dl,
reduce
When serum glucose
between 4 and 5
insulin infusion serum to 0,2-0,005
reaches 250 mg/dl,
mEq/L
IU/kg/h Keep serum glucose between
changes to 5% dextrose at
150 and 200 mg/ dl until resolution
50-250 ml/h with added
of DKA
NaCl in the infasion bottle
Check electrol test urea or BUN, creatine and glucose every 2-4 hrs until stable. Afterresolution of DKA and when
patitent is able to end. Initiate SC multidose insulin regmen. To transfer from IV to SC, continue IV insulin infusion for
1-2 hours after SC insulin begun to ensure adequate serum insulin levels. Insulin naive patients, start at 0,5-0,8 IU/kg
per day and adjust as needed. Always examine for precipitating causes to prevent recurrence.

but

Counter-regulatory
hormones

Absolute Insulin
Deficiency

Protein syntesis

Lipolysis
FFA to Liver

Relative
insulin
deficiency

Proteolvsis
Absent or
minimal
ketegenesis

++
Gluconeogenenic substrates

Ketogenisis
Alkali Reserve

Glucose
Utilization

Glucose
Utilization

Glycogenolysis

Hyperglyce
mia
Glycosuria (osmotic diuresis)

Ketoacidosis
Triacylglycerol

Loss of water and electrolytes

Dehydration

Hyperosmolar
Hyperlipidermi
ity a

Decreased
Fluid intake

Impared renal fuction

HH
DK