DIABETES MELLITUS-KETOACIDOSIS INX & MGM

SUMMARY

1. Findings: metabolic acidosis, hyperglycemia, hypokalemia, hypophosphatemia, pseudohyponatremia.

2. Pseudohyponatremia: serum Na⁺ is usually decreased because of the osmotic shift of water from inside cells to the intravascular space caused by the hyperglycemia.

3. Start IV insulin at 0.1 units/kg/hr. Keep the IV insulin going until the acidosis is resolved and anion gap is normal.

4. K⁺ is shifted into the cells by both the reversal of acidosis and the action of insulin, further aggravating the hypokalemia and possibly leading to cardiac arrest.

5. Monitor the heart-wave morphology and rhythm for any K⁺-associated changes.

6. Bicarbonate is given only for pH < 7.0, especially if the patient is having respiratory or hemodynamic compromise.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].