Before beginning insulin therapy, start intravenous fluids. Before beginning insulin therapy, the potassium level should be greater than 3.3 mEq/L. (supplement potassium intravenously if needed).
The restoration of extracellular fluid volume through intravenous infusion of a normal saline (0.9 percent sodium chloride) solution is the first step in the treatment of diabetic ketoacidosis.
Hyperglycemia, metabolic acidosis, and ketoacidosis are its defining features. DKA results from insulin deficiency, either with or without a triggering event that triggers a series of pathophysiological alterations. Normalizing volume status, hyperglycemia, electrolytes, and ketoacidosis are the objectives of DKA treatment.
When the following conditions are met: 1) venous blood pH >7.3; 2) serum bicarbonate concentration 15 mEq/L; 3) plasma glucose 200-250 mg/dL; and 4) anion gap 12, DKA is resolved. In general, the cessation of insulin infusion requires only the resolution of hyperglycemia, normalization of bicarbonate levels, and closing of the anion gap.
When beginning treatment for an adult with DKA (0.1 units/kg), it is customary to administer a bolus of 6 units followed by an infusion of 6 units/h.
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