Diabetic Ketoacidosis Drug Therapy

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Drug Therapy

* Begin rehydration for DKA immediately.
* Begin insulin therapy when serum electrolytes are available.
* Monitor potassium levels closely and replace potassium deficit in all patients with DKA.
* Determine the need for bicarbonate therapy.

Drug Treatment for Diabetic Ketoacidosis (table)

Begin rehydration for DKA immediately. BC

* Begin treatment with normal saline (0.9% sodium chloride).
* Reassess fluid replacement hourly.
* Switch to 0.45% sodium chloride after the initial bolus if the serum sodium is high or normal.
* Begin fluid infusion at an initial rate of 15 to 20 mL/kg?h depending on the fluid deficit; switch to dextrose containing fluids once the blood sugar level is approximately 250 mg/dL.
* Use extra caution in children, who have higher incidence of cerebral edema associated with DKA therapy, and in children at risk of pulmonary edema.
* See table Drug Treatment for Diabetic Ketoacidosis.


Begin insulin therapy when serum electrolytes are available. B

Author: Heather Lochnan, MD
Module updated - 2007-12-11

* Begin treatment with iv regular insulin if serum potassium is >=3.3 mEq/L.
* If K is <3.3 mEq/L, hold insulin, replace K at 40 mEq/h and monitor frequently.
* Use an initial bolus of approximately 0.15 U/kg?h iv, followed by an infusion of 0.1 U/kg.
* If the blood glucose is <250 mg/dL, begin treatment with 5% or 10% dextrose in water and monitor therapy using the anion gap and presence of serum ketones.
* See table Drug Treatment for Diabetic Ketoacidosis.