Diabetic Ketoacidosis Care Presents Real Challenges : In addition to diagnosis and management, look for potential triggers of this acute metabolic disorder.

“In reality, there are some studies that have shown that giving bicarbonate in DKA doesn't make a difference either way, so it should probably be avoided” Dr. Hulsey said. Bicarbonate should not be used in pediatric patients, because of a possible association with cerebral edema, he said.

As noted, replacing potassium deficits should be included in the DKA management strategy. The dose will vary depending on serum levels, which should be measured regularly so that the rate of replacement can be adjusted as needed, Dr. Hulsey noted.

Finally, determine the trigger event and provide patient education as needed to prevent recurrences. Infection, serious illness, trauma, and emotional stress can all lead to the acute diabetic disorder, as can other medications, alcohol, and inappropriate cessation of insulin or reduction of the insulin dosage.

Patients should be made aware of the range of possible precipitating factors. They also should be cognizant of early signs and symptoms that might suggest the need for insulin adjustment, before the situation escalates to an emergency, Dr. Hulsey concluded.