Diabetic Ketoacidosis (DKA) (E10.1, E11.1)
Lab
- CBC, BUN/Cr, electrolytes, Mg, Phosphate, VBG,
ketone
- Serum Osmolality (if HHS or mixed picture suspected) OR calculated effective Posm (= 2×Na (mEq/L) + glucose (mg/dL)/18)
- Anion Gap calculation
- HbA1c (new diagnosis or unknown control)
- Serum Lactate (if sepsis or shock suspected)
- Blood culture ×2 sets (if infection suspected)
- Urinalysis ± Urine culture
- β-hCG (women of childbearing age)
Investigation
- 12-lead ECG (especially for potassium abnormalities)
- Continuous Cardiac Monitor (moderate-severe DKA or K⁺ abnormality)
- CXR (if pneumonia suspected)
- Additional imaging directed by suspected precipitating cause (e.g., CT abdomen, CT brain)
ER Treatment
- ABC assessment, Cardiac monitor, IV access ×2
- Identify and treat the precipitating cause (infection, MI, stroke, insulin omission, pancreatitis, etc.)
- Balanced Crystalloid 15–20 mL/kg (≈1–1.5
L) during first hour then
- Corrected Na <135 → คง isotonic 250–500 mL/ชม.
- Corrected Na ≥135 → เปลี่ยนเป็น 0.45% NaCl 250–500 mL/ชม.
- Add KCl 10-20 mEq/L to each liter of IV fluid
- If K < 3.5: stop insulin, Replace KCl 10-20 mEq/h
- RI 100 unit + NSS to 100 mL sig IV drip 0.1 U/kg/h (start if K > 3.5 mEq/L)
- 7.5% Sodium Bicarbonate 100 mmol + Sterile water 400 mL sig IV drip in 2 h (if pH < 7.0 หรือ K > 6.4 mEql/L) +/- add KCl 20 mEq (if K < 5.0)
Monitoring
- POCT glucose q 1 h until stable then q 2 h
- BUN, Cr, electrolytes, VBG q 2-4 h
- Serum ketone q 2 h
