Management of Starvation Ketosis with Dextrose Infusion
Initial Assessment and Diagnosis
- Starvation ketosis is distinguished from diabetic ketoacidosis (DKA) by clinical history and plasma glucose concentrations that range from mildly elevated to hypoglycemic, with serum bicarbonate typically not lower than 18 mEq/L 1
- Laboratory evaluation should include plasma glucose, blood urea nitrogen, creatinine, serum ketones, electrolytes with calculated anion gap, osmolality, urinalysis, and arterial blood gases 1
Dextrose Infusion Protocol
- Begin with isotonic saline (0.9% NaCl) at 15-20 ml/kg/hour during the first hour to restore circulatory volume and tissue perfusion 1
- Once hypovolemia is corrected, transition to dextrose-containing fluids 1
Electrolyte Management
- Once renal function is assured and serum potassium is known, add 20-30 mEq/L potassium (2/3 KCl and 1/3 KPO4) to the infusion until the patient is stable and can tolerate oral supplementation 1
Monitoring and Ongoing Management
- During therapy, blood should be drawn every 2-4 hours for determination of serum electrolytes, glucose, blood urea nitrogen, creatinine, and osmolality 1, 3
- Monitor for signs of cerebral edema, particularly if rapid correction of osmolality occurs 3
Transition to Oral Intake
- Consuming 15g of carbohydrates will raise blood glucose by approximately 40 mg/dl over 30 minutes 4
- Pure glucose produces a greater rise in plasma glucose than equivalent amounts of carbohydrate from other sources 4
- Oral ingestion of 150-200g of carbohydrate per day (45-50g every 3-4 hours) will reduce or prevent starvation ketosis 2