ELECTROLYTES
what is the most common electrolyte abnormality in DKA on presentation?
Potassium (total body deficit)
What is the recommended type of fluid for initial resuscitation?
0.9% normal saline
At what point should insulin be initiated in DKA management?
after initial resuscitation and K>3.3 mEq/L
What is the K threshold below which insulin should not be started?
<3.3 mEq/L
How long should basal insulin given before stopping the insulin drip?
1-2 hours
At what magnesium level should you consider replacement?
<1.7 mg/dL
How much fluid deficit is typically present in moderate or severe DKA?
5-8 L
What is the standard dose of IV regular insulin in DKA?
0.1 units/kg
if K 3.4 mEq/L, what should you do before starting insulin?
replace potassium first
What criteria should be met before transitioning off the insulin drip
AG<12, HCO3>18, pH>7.30, pt able to eat
Why should phosphate replace be selective in DKA?
no proven benefits unless severe (<1.0 mg/dL), cardiac dysfunction, respiratory failure
When should you switch from NS to dextrose-containing fluids?
when BG <200-250 mg/dL
When should dextrose be added to fluids during DKA management?
When BG <200-250 mg/dL
How often should potassium be rechecked after replacement?
q2-4h
What is the recommended TDD of insulin for most adults?
~0.5 units/kg/day
What acid-base abnormality is most characteristic of DKA?
HAGMA (low pH, Low HCO3, high AG)
What is the goal of fluid therapy in the first 1-2 hours?
restore perfusion, intravascular volume and tissue oxygenation
Why is insulin continued even after glucose normalizes?
to stop ketogenesis and close AG
What is the sign of overreplacement of potassium?
ekg with peaked T waves and prolonged PR, weakness
what type of sc insulin is preferred at transition?
basal-bolus regimen (preferred over SSI)
Which electrolyte during treatment can worsen arrhythmia?
Hypokalemia (low potassium can worsen with insulin therapy)
In patients with renal failure, how should fluid resuscitation be modified?
give smaller boluses (250-500 mL) and monitor closely for volume overload and pulmonary edema
What is the main action of insulin that corrects DKA (not glucose)?
insulin suppresses lipolysis and ketone production
Name two that increase total body potassium loss in DKA?
osmotic diuresis, vomiting, albuterol use, metabolic acidosis
why is overlap of basal sc insulin with IV insulin important?
prevents rebound hyperglycemia and recurrence of DKA