Diabetic Ketoacidosis Author: Heather Lochnan, MD
Approved for review - 2009-03-25
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
Figures
References
Glossary
What's New
Patient Information
Additional Resources
Tools
Frequently Asked Questions
Prevention
What advice should be given to patients regarding sick day management of type 1 diabetes?
When should the patient go to the emergency room?
Are low levels of ketones in blood or urine diagnostic of diabetic ketoacidosis?
Screening
Should patients with type 2 diabetes be screened for DKA?
Is capillary ketone measurement helpful in screening for DKA?
Is the measurement of urine ketones reliable?
Diagnosis
Are arterial blood gases required to make the diagnosis of DKA?
If the urine dipstick for ketones is negative, is DKA excluded?
If the serum glucose is only mildly elevated, can the patient have DKA?
Consultation for Diagnosis
Should everyone with DKA be referred to a diabetologist?
What tests are helpful in diagnosing DKA?
When should patients with DKA and abdominal pain be referred to a general surgeon?
Hospitalization
When can patients be discharged directly from the emergency room?
Which patients require admission to intensive care?
How is cardiac monitoring useful with regard to potassium replacement?
Drug Therapy
What is the best iv fluid to use for rehydration?
Is bicarbonate therapy ever indicated?
When can subcutaneous insulin therapy be restarted?
Is phosphate replacement necessary?
Patient Education
Should all patients with a history of type 1 diabetes mellitus be on a regimen of multiple daily injections of insulin?
Should patients test for ketones, either urine or capillary, after discharge from hospital?
What advice should be given to patients regarding what to do if blood sugars are elevated after discharge from hospital?
Consultation for Management
Do all cases of DKA require a consult with a diabetologist?
How will I know when to obtain a consult with a general surgeon for abdominal pain and tenderness?
When should a nephrologist be consulted to help manage renal failure associated with DKA?
Follow-up
How often should arterial blood gases be done?
When should the patient be seen in clinic after discharge from hospital?
How much subcutaneous insulin should be used in a patient not previously on insulin therapy?
| Patient Information
Ebenezer A. Nyenwe, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Heather Lochnan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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