Endocrine
Diabetic ketoacidosis
Order fluid, potassium, and insulin so that insulin is not given into dangerous hypokalemia.
Educational only. A local note appears only when a public source is attached. This page does not say that one exam, or training in one country, makes you eligible to practice in another.
Global core
Diabetic ketoacidosis is hyperglycemia, ketones, and an anion-gap acidosis. Treatment is fluid, insulin, and potassium, plus the trigger. Insulin must not be started when potassium is already dangerously low, because insulin drives potassium into cells. Bicarbonate is not routine.
What stays the same
- Ketoacidosis is glucose, ketones, and an anion-gap acidosis, plus a trigger.
- Insulin shifts potassium into cells.
- Bicarbonate is not the opening drug.
- Recognize. Vomiting, deep breathing, dehydration, and known or new diabetes.
- Reason. Glucose, ketones, blood gas, and potassium define the emergency and the first drug.
- Prioritize. Airway, shock, and a low potassium before a tidy infusion protocol.
- Act safely. Fluid first in shock. Replace potassium. Start insulin once potassium is safe.
Local adaptation
No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.
Exam lens
The order of fluids, potassium, and insulin.
Original case · shared decision
The lens above is how that exam usually frames the medicine. This case stays on the shared decision. Not an official examination item.
A 19-year-old man with type 1 diabetes is vomiting. Glucose is 28 mmol/L (about 504 mg/dL), ketones are high, pH is 7.12, and potassium is 2.8 mmol/L. He is protecting his airway and his blood pressure is 110/70 mm Hg. What is the most important caution?