Diabetic Ketoacidosis

Diabetic ketoacidosis is a severe and potential life-threatening complication of diabetic mellitus. Glucose levels are usually moderately elevated, however they can range from normal/slightly increased levels (euglycemic states) to high levels exceeding 900 mg/dl in comatose patients. The treatment relies on fluid & electrolyte replacement, insulin administration and glucose administration.

Guidelines of from different regions have variations in therapy, for instance the ADA suggests half-isotonic (0.45 %) saline in the fluid replacement regime, the Joint British Diabetes Society and the German guideline recommend 0.9 % in almost all cases. In the European pediatric guidelines, the use of “a solution with a tonicity ≥0.45 %” is recommended, stating that 0.9 % or 0.45 % with added potassium can be used. Due to the various recommendations, the reader is advised to also consult local hospital guidelines on fluid therapy.


When treated with SGLT2 inhibitors, the resulting glucosuria can minimize the developing hyperglycemia.

DKA can develop due to insulin deficiency. In non insulin-dependent patients however (i.e. d.m. type 2 with remaining insulin production) the DKA has often an underlying cause that needs to be identified, including infection, trauma, mediation, etc.


Fluids and Electrolytes

Insulin and Glucose


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