At least hourly observations should be recorded whilst in the Emergency Department. Any significant changes should be reported immediately to the medical team.
Anticipate and monitor for early signs of clinical cerebral oedema (e.g. headaches (are often one of the earliest symptoms), deteriorating conscious level, falling heart rate, rising blood pressure)
Risk factors for cerebral oedema are: low pH, elevated serum urea and low CO2 at presentation
Continuous cardiac monitoring (for potassium related abnormalities)
Weight on arrival
Hourly fluid input/output
Baseline and hourly BGL and blood ketones
Keep a sampling line patent using a non-glucose containing fluid
Two hourly blood gas
All urine samples are to be tested for glucose and ketones
Flushing the line with solution prior to commencing the insulin infusion as per the DKA fluid calculator prevents insulin from binding to the tubing.
WA Health, Child and Adolescent Health Service. PMH Department of Endocrinology and Diabetes. Management of Diabetic Ketoacidosis (DKA). Not yet published.
2. Goldberg A, Kedves A, Walter K, Groszmann A, Belous A, Inzucchi SE. “Waste not want not”: Determining the optimal priming volume for intravenous insulin infusions. Diabetes Technol Ther. 2006 Oct;8(5):598-601
External Consultation Fiona Frazer (Endocrine Consultant) and PMH Endocrine Team: March 2015