Diabetic Ketoacidosis (cont.)
How to Treat Diabetic Ketoacidosis
- Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte.
- Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar).
- People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit.
- Some people with mild acidosis with modest fluid and electrolyte losses, and who can reliably drink fluid and follow medical instructions can be safely treated and sent home. Follow-up must be available with a health care practitioner. Individuals with diabetes who are vomiting should be admitted to the hospital or urgent care center for further observation and treatment.
Diabetic Ketoacidosis Follow-up
- In cases of mild dehydration with borderline diabetic ketoacidosis, you may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner.
- Whether you are released to go home or monitored in the hospital, it is important that close monitoring of blood sugar and urinary ketone levels be continued. Elevated blood sugars should be controlled with extra insulin doses and drinking plenty of sugar-free fluids.
- Long-term care should include periodic follow-up with your health care practitioner to achieve good control of blood sugars. Care includes screening for and treating the complications of diabetes by periodic blood tests of hemoglobin A1C, kidney function, and cholesterol, as well as an annual eye examination and regular inspection of the feet (for evidence of wounds or damage to nerves).
Medically Reviewed by a Doctor on 4/5/2016
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