Management of Adults with Diabetic Ketoacidosis
Figure 1. Algorithm for the management of adults with diabetic ketoacidosis. (NaCl = sodium chloride; IM = intramuscular; IV = intravenous; SC = subcutaneous.)
Adapted with permission from Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, et al. Hyperglycemic crises in diabetes. Diabetes Care 2004;27(suppl 1):S96.
Management of Patients Younger than 20 Years with Diabetic Ketoacidosis* or Hyperosmolar Hyperglycemic State†
*-Diagnostic criteria: blood glucose > 250 mg per dL, venous pH < 7.3, bicarbonate < 15 mEq per L, moderate ketonuria or ketonemia.
†-Diagnostic criteria: blood glucose > 600 mg per dL, venous pH > 7.3, bicarbonate > 15 mEq per L, and altered mental status or severe dehydration.
‡-After the initial history and physical examination, immediately obtain blood glucose, venous blood gases, electrolytes, blood urea nitrogen, creatinine, calcium, phosphorus, and urine analysis.
§-Usually 1.5 times the 24-hour maintenance requirements (about mL per kg-1 per hour-1) will accomplish a smooth rehydration; do not exceed two times the maintenance requirement.
||-The potassium in solution should be 1/3 potassium phosphate and 2/3 potassium chloride or Kacetate.
