Blogging has slowed a bit as I’ve been travelling to the UK and am running courses here all week.
Just in case you’re desperate to read something useful, I came across a guideline on The Management of Diabetic Ketoacidosis in Adults by the Joint British Diabetes Societies Inpatient Care Group
The guideline contain the following approaches:
- Measurement of blood ketones, venous (not arterial) pH and bicarbonate and their use as treatment markers
- Monitoring of ketones and glucose using bedside meters when available and operating within their quality assurance range
- Replacing ‘sliding scale’ insulin with weight-based fixed rate intravenous insulin infusion (IVII)
- Use of venous blood rather than arterial blood in blood gas analysers
- Monitoring of electrolytes on the blood gas analyser with intermittent laboratory confirmation
- Continuation of long acting insulin analogues (Lantus® or Levemir®) as normal
- Involvement diabetes specialist team as soon as possible
There is also a section on ‘Controversial Areas’, discussing such issues as bicarbonate therapy, rate of fluid therapy, and even 0.9% saline versus Hartmann’s (Ringer’s Lactate) solution, although this part was desperately disappointing, with the following bizarre excuse given for not recommending the latter:
“In theory replacement with glucose and compound sodium lactate (Hartmann’s solution) with potassium, would prevent hyperchloraemic metabolic acidosis, as well as allow appropriate potassium replacement. However, at present this is not readily available as a licensed infusion fluid.“
Apart from that, this appears to be an interesting and potentially useful document.
The Management of Diabetic Ketoacidosis in Adults
Joint British Diabetes Societies Inpatient Care Group