Management of Diabetic Ketoacidosis

Initial Treatment Approach

Aggressive fluid resuscitation with isotonic saline at 15-20 mL/kg/hour is recommended to restore circulatory volume and tissue perfusion in patients with diabetic ketoacidosis (DKA) 1
Continuous intravenous insulin infusion at 0.1 units/kg/hour should be maintained until resolution of ketoacidosis, regardless of glucose levels, in DKA patients 1, 2
Electrolytes, particularly potassium, should be monitored and replaced as needed in patients with DKA 1, 2

Once DKA is resolving and the patient is able to eat, they should transition to a multiple-dose insulin schedule using a combination of short/rapid-acting and intermediate/long-acting insulin, as recommended by the American Diabetes Association 3, 2
Blood should be drawn every 2-4 hours to determine serum electrolytes, glucose, and other parameters to monitor resolution of acidosis in DKA patients 2
DKA resolution requires glucose <200 mg/dL, serum bicarbonate ≥18 mEq/L, venous pH >7.3, and anion gap ≤12 mEq/L, according to the American Diabetes Association guidelines 2

The American Diabetes Association guidelines do not recommend keeping DKA patients NPO as a standard practice, and instead suggest allowing patients to eat when they are able to, while providing appropriate insulin coverage 3
For patients who cannot eat, intravenous insulin and appropriate fluid management should continue until oral intake is possible, with glucose targets between 150-200 mg/dL until DKA resolution parameters are met 2

Resolution of hyperglycemia is a key component of DKA management, as recommended by the American Diabetes Association 4
Treatment of underlying causes, such as sepsis, myocardial infarction, and stroke, is crucial in DKA management, according to the American Diabetes Association 5
Prevention of complications, including thromboembolism, is an essential aspect of DKA management, as suggested by the American Diabetes Association 4, 5

A hypercoagulable state associated with DKA increases the risk of thrombosis, as reported by the American Diabetes Association 4
Enoxaparin can be administered to DKA patients as part of standard hospital thromboprophylaxis protocols, as recommended by the American Diabetes Association 5

Renal function should be monitored regularly, as insulin therapy and fluid resuscitation can improve kidney perfusion and change enoxaparin clearance, according to the American Diabetes Association 5
Enoxaparin can be started upon admission after initial fluid resuscitation has begun, as suggested by the American Diabetes Association 5
Enoxaparin administration should not interfere with the standard DKA management protocol, which includes intravenous fluids, insulin therapy, and electrolyte replacement, as recommended by the American Diabetes Association 4, 5