TREATMENT PROTOCOL

DKA,HHS,HYPOGLYCEMIA
5% dextrose saline
 ADA 2019: Bicarbonate use in DKA

• Several studies have shown that the use of

bicarbonate in patients with DKA made no difference
in resolution of acidosis or time to discharge, and its
use is generally not recommended
 ADA 2019: Bicarbonate use in DKA

Intravenous sodium bicarbonate therapy in severely

acidotic diabetic ketoacidosis initial pH < 7 (Duhon
et al)
• No difference in time to resolution of acidosis (10
hours vs 12 hours; p = 0.28), hospital length of stay
(68 hours vs 70 hours; p = 0.87), and intravenous
crystalloid requirement (8.8 L vs 7.3 L; p = 0.09) for
patients presenting patients with a pH less than 6.9

Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5.

HYPERGLYCAEMIC HYPEROSMOLAR STATE
• INITIAL EVALUATION (0-15 min)
- Rapid and comprehensive clinical evaluation including vital signs,
volume and mental status.
- Insert 2 large bore cannula. Investigations: blood glucose, blood gases,
full blood count, urea and electrolytes, ECG, CXR, blood culture,
urinalysis and culture, HbA1c, TSH
-Calculate Osmolality (2Na + glucose +urea)

• IMMEDIATE MANAGEMENT (0-60 minutes)

-Commence IV 0.9% sodium chloride 1L to run over 1hour
-Insert urinary catheter, monitor hourly urine and calculate fluid balance
-Administer intravenous antibiotics if sepsis identified/suspected
-Commence prophylactic LMWH.
- Consider central venous catheter and continuous cardiac monitoring.
-Nasogastric tube insertion
Where to now?