Diabetic Ketoacidosis (DKA) — Physical and Laboratory Monitoring, Electrolytes Abnormalities — Clinical Pathway: Emergency Department, ICU and Inpatient

Diabetic Ketoacidosis (DKA) Clinical Pathway — Emergency Department, ICU and Inpatient

Physical and Laboratory Monitoring, Electrolytes Abnormalities in DKA

Physical and Laboratory Monitoring

  • Continuous CR Monitoring
  • Full VS with HR, RR, BP, O2 Sat q15 minutes until the child is stable, then hourly
  • Hourly Neuro checks in ED and ICU
  • Use DKA Flowsheet
Lab, Monitoring Frequency
POC Glucose Hourly
BMP, Mg, Phos, Ca Every 2 hrs
Neuro Checks Hourly in ED, ICU
VBG Every 2 hrs until pH > 7.0
POC BOHB or Urine Ketones POC BOHB every 2 hrs
If using UA – all urines
ECG K < 2.5 or K > 6.0
K < 3.5 requiring high infusion K > 60 mEq
Telemetry Review need with Endocrine, Cardiology

Electrolyte Abnormalities in DKA

  • DKA results in an anion gap metabolic acidosis due to the production of ketoacids beta-hydroxybutyrate and acetoacetate
  • Normal anion gap is 12 ± 2
Electrolyte
Sodium
  • Typically, low due to urinary losses and fluid shift to extracellular space due to high
    serum osmolality
  • Gradually rises with treatment
  • CHOP lab corrects for lipemia but not for hyperglycemia
  • Na is reduced 1.6 mEq/L for each 100 mg/dL rise in blood glucose
  • Use this formula to calculate the corrected serum Na:
    • Nacorrected = Nameasured + (1.6 × [(Glucose − 100) / 100])
Chloride
  • May become elevated during treatment due to use of 0.9% NS
  • Can result in hyperchloremic metabolic acidosis
Potassium May be low, normal, or high, but total body stores are low due to renal losses
Bicarbonate
  • Low, consistent with metabolic acidosis
  • Insulin will correct acidosis over time
  • Na HCO3 is not recommended, linked to risks including hypokalemia, cerebral edema
BUN, Creatinine Elevated due to dehydration
Phosphorous
  • Low due to renal losses
  • Can lead to decreased oxygen delivery to tissues causing lactic acidosis
Magnesium Low due to renal losses
Calcium Low due to renal losses