Lightning Learning: DKA in Adults

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STOP!

Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed and managed promptly.

How common is DKA?¹

Nearly 4% of people with type 1 diabetes experience DKA each year, about 8% of episodes occur in inpatients who didn’t primarily present with DKA.

Diagnostic criteria³ (all 3 must be present)

1. Ketonaemia ≥3.0 mmol/L or 2+ ketonuria
2. Blood glucose >11.0 mmol/L or known diabetes mellitus
3. Bicarbonate <15.0 mmol/L and/or venous pH <7.3

Causes of death associated with DKA?

• Cerebral oedema
• Hypokalaemia, hypoglycaemia
• Adult Respiratory Distress Syndrome (ARDS)
• Infections/sepsis
• DKA is prothrombotic (e.g. PE/MI)

DKA IS FATAL IF NOT TREATED!

LOOK

Aims³

• Replacement of fluid deficit
• Insulin treatment
• Monitoring and maintaining electrolyte, potassium balance
• Avoiding complications of treatment

Management

1. Treat the patient in ER with full monitoring
2. Rapid ABCDE assessment
3. IV access, bloods (e.g. VBG, blood ketones, FBC, U&E, LFT, CRP, coagulation profile, consider blood cultures) & ECG
4. Start DKA care pathway
5. Look for precipitating cause (e.g. infection)
6. Input/output monitoring

DKA Treatment Pathway² (0-60 minutes)

• Commence IV 0.9% sodium chloride
• Fixed rate insulin infusion (FRII) at 0.1 units/kg/h
• Give IM/SC actrapid 10 units if delay in diagnosis/commencing FRII.
• Potassium replacement if needed (see DKA chart below)
• Hourly BM, ketones, VBG
• Review IV fluids accordingly
• Give long-acting insulin
• Patients with DKA will be admitted to the Acute Care Bay (ACB) or ITU depending on severity

LEARN

DON'T FORGET! Patient education is the best prevention ➔ www.dafne.uk.com

References:

1. Diabetic Ketoacidosis (Patient.info)
2. DKA guideline prescription chart (UHL)
3. Guidelines for the management of DKA in adults (UHL)
4. Diabetic Ketoacidosis in Adults (BMJ)