Library
Endocrine
·
hard
Diabetic Ketoacidosis
Flowchart
Play
Fluids → insulin → potassium replacement.
Decision
Outcome
Decision
DKA confirmed (glucose >250, anion gap, ketones, pH <7.3). First action?
✓
IV fluids: isotonic saline 1–1.5 L bolus, then maintain
✗
IV insulin bolus before fluids
Decision
Next — when to start insulin and what about potassium?
✓
Check K+: if <3.3 hold insulin, replete K first. If 3.3–5.3 start insulin + replete K. If >5.3 start insulin no K
Decision
Glucose drops to ~200 — switch to?
✓
Add D5 to fluids; continue insulin until anion gap closes
✗
Stop insulin once glucose <200
Outcome
Transition to subcutaneous insulin only after anion gap closed and overlapping IV insulin for 1–2 h
Bicarbonate only if pH <6.9. Address precipitant (infection, MI, missed insulin).