PulmCrit
PulmCrit- September 26, 2016 - By Josh Farkas
"Management of acidosis in DKA is an ongoing source of confusion. There isn’t much high-quality evidence, nor will there ever be. However, a clear understanding of the physiology of DKA may help us treat this rationally and effectively...
- During a DKA resuscitation, patients may display different types of metabolic acidosis. Understanding the physiologic problem will facilitate logical and effective treatment.
- Occasionally patients present with severe ketoacidosis. Treatment for this involves maximally aggressive therapy for DKA:
- Adequate insulin doses (possibly with a loading bolus)
- Aggressive volume resuscitation with balanced crystalloid
- High-flow nasal cannula may be considered to support the patient’s respiratory compensation
- Many patients will have a mild non-gap acidosis during the resolution phase of DKA. Although not life-threatening, this may prolong the length of stay and increase the risk of recurrent DKA after stopping the insulin drip. Isotonic bicarbonate is a rational therapy for this problem.