UMEM Educational Pearls

Diabetic Ketoacidosis Treatment:

  • At least at our academic medical center, we find it very hard to get a DKA patient admitted to an ICU or IMC while they are still in DKA.  Typically, we can correct the acidosis and downgrade them to a floor bed before their ICU/IMC bed is available.
  • Some key points to remember when managing DKA in the ED.
    • The mainstay of treatment for the hyperglycemia initially is IV fluids.
    • Check labs often and replete Magnesium and Potassium early.
    • Insulin should not be started until the potassium is confirmed to be >3.3 mEq/L
    • Patients can still be in DKA even though there glucose is normal.
    • Intravenous insulin must be continued until all the ketones are cleared. 
    • Add D5W or D10 if needed to ensure that their glucose levels stay up but do not stop the insulin.
    • Patients need to receive a long acting insulin (i.e.: Lantus or NPH) 2 hours before the insulin drip is stopped.  Placing a patient only on Sliding Scale Insulin will almost guarantee that they go back into DKA on the floor.
    • Typically you can just restart the patients home long acting insulin, but if you are leary about hypoglycemia if they are not eating well, then give them 3/4 their home dose.


Charfen MA, Fernadez-Frackelton M. Diabetic Ketoacidosis. EMCNA 2005:609-628.