DKA Plan

Initial Labs:
-  Anion Gap: _
-  pH: _
-  Potassium: _
-  Bicarbonate: _
-  Blood Glucose: _
 
Insulin: 
-  Initial: 0.1U/kg bolus followed thereafter by 0.1U/kg/hr infusion
-  Serum Glucose: < 200 mg/dL, reduce insulin to 0.02-0.05 U/kg/hr IV
-  May consider transitioning to SC insulin, run IV insulin with SC for 2-4 hours before completing transition
-  If insulin naïve patients, start SC insulin 0.5 to 0.8 U/kg per day
 
IV Fluids: 
-  Initiate 1 L NS per hour. 
-  If elevated/normal serum Na run 0.45% NaCl at 250-500 ml/hr
-  If low serum Na run 0.9% NaCl at 250-500 ml/hr
-  If serum glucose < 200 mg/dL, change to D5 ½ NS at 150-250 ml/hr
 
Potassium: 
-  Potassium < 3.3 mEq/L, hold insulin and give 20-40 mEq/hr
-  Potassium 3.3 to 5.3 mEq/L, give 20-30 mEq/L
-  Potassium > 5.3 mEq/L, do not give supplemental potassium and recheck q2hr
 
Labs: Monitor BMP and venous pH every 2 to 4-hour until stable
Diet: N.p.o.
DVT PPx: Graduated compression stockings
 
Disposition: Patient to remain acute inpatient. Plan to transition to subcutaneous insulin once glucose levels, bicarb, potassium have been normalized. Intravenous insulin should be continued for 2 to 4 hours after initiation of subcutaneous insulin.