Episode 30: Diabetic ketoacidosis

Diabetic Ketoacidosis (DKA) management requires a systematic approach to fluid resuscitation, insulin therapy, and electrolyte correction. Initial assessment focuses on confirming the diagnosis through anion gap metabolic acidosis and hyperglycemia, while ruling out concurrent infections or triggers. Fluid management prioritizes achieving euvolemia using balanced crystalloids like Lactated Ringer’s, rather than excessive normal saline, to avoid hyperchloremic acidosis. Insulin therapy, typically administered via IV drip, should be titrated based on glucose levels and anion gap closure, with a transition to subcutaneous insulin once the gap resolves. Potassium management is critical, as levels shift significantly during treatment, necessitating frequent monitoring and replacement. Ultimately, DKA serves as a foundational model for critical care, emphasizing the importance of treating underlying metabolic derangements and understanding the physiological shifts that occur during acute illness.