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TEST






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Text Box: ¨ Please refer to pharmacy guidelines for potassium 
administration
Text Box: ** At this point consider split IV fluids,
one line 
for glucose infusion, another
line for fluid 
administration
Text Box: * For severe hyperosmolar state with mental 
status
change need to assure not over rapidly 
correcting
glucose due to fear of cerebral edema (>50 mg/dL/br)

more frequent labs and monitoring warranted.
Text Box: Check chem 7 every 2 to 4 hrs. until patient is stable. Look 
again for precipitating causes. After resolution of diabetic ketoacidosis, 
obtain blood glucose level every 4 hours, and give
sliding-scale 
regular insulin SC in 5-U increments for every 50 mg/dL increase above 150 
mg/dL to a maximum of 20 U. 
Text Box: Give hourly IV 10-U
insulin bolus 
until
blood glucose level falls by 50 to 70 mg/dL
Text Box: Double insulin infusion
hourly until blood 

glucose level falls by 50 to 70 mg/dL
Text Box: If serum potassium level is
>3.3 mEq/L but 
<5.5 mEq/L,
give 20 to 40 mEq of
potassium in each 
liter of 
IV fluids (two thirds as
potassium chloride 
and
one third as potassium
phosphate) to keep 
serum
potassium level at 4.0 to 5.0 mEq/L
Text Box: If serum potassium level is
>5.5 mEq/L, do not 
give
potassium but check level
every 2 hours
Text Box: If serum potassium level is
<3.3 mEq/L, give 20 
mEq of KCl over one hour and repeat for a second dose to give a total of 40 
mEqKC1 IV. Recheck K+ level after second dose.
Text Box: Potassium ¨ 
Text Box: Changes to 5% dextrose in 0.45% saline administered at 100 to 
200 mL/hour, with adequate insulin (0.05 to 0.1 U/kg/hour as IV infusion) 
given to keep blood glucose level between 150 and 200 mg/dL(8.3 and 11.1 
mmol/L ) until metabolic control is achieved
Text Box: When serum glucose reaches 250 mg/dL (13.9 mmol/L): 
**
Text Box: If blood glucose level does not fall by 50 to 70 mg/dL (2.8 
to 3.9 mmol/L ) in the first hour:
Text Box: Administer regular insulin, 0.1 U/kg/hour as IV 
infusion
Text Box: Administer regular insulin, 0.15 U/kg as IV bolus
Text Box: IV route
Text Box: Insulin
Text Box: Diagnosis criteria for diabetic ketoscidosis:
•Blood 
glucose level > 250 mg/dL (13.9 mmol/L)
•Arterial pH 
<7.3
•Serum bicarbonate level < 15 mEq/L
•Moderate 
Ketonuria and ketonemia
Text Box: Initial evaluation (perform immediately):
•History 
and physical examination
•Laboratory tests: serum pH, complete 
blood count with differential, 
urinalysis, blood glucose, blood 
urea nitrogen, creatinine, electrolytes (chem 7)

•Electrocardiogram
•Chest radiography and cultures as 
needed
•Start IV fluid: 1 L of 0.9% sodium chloride per hour 
initially (15 to 20 mL/kg/hour)
Text Box: Management of Diabetic Ketoacidosis
Text Box: Administer 0.45% sodium
chloride (7 to 14 mL/kg/hour)

depending on hydration status
Text Box: Administer 0.9% sodium
chloride (7 to 14 
mL/kg/hour), depending on hydration status
Text Box: Serum sodium
level low
Text Box: Serum sodium
level normal
Text Box: * Serum sodium 
level high
Text Box: Evaluate corrected serum sodium level
Text Box: Hemodynamic
monitoring
Text Box: Administer
0.9% sodium
chloride (1 L/ hour)

and/or plasma expander
Text Box: Cardiogenic
Shock
Text Box: Mild
Hypotension
Text Box: Hypovolemic
Shock
Text Box: Determine hydration status 
Text Box: IV 
fluids

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