Synopsis
Diagnose adult diabetic ketoacidosis from ketones and acidosis, deliver protocolised resuscitation, measure biochemical response and correct the precipitating insulin deficit.
- JBDS adult diagnostic criteria combine diabetes or glucose above 11 mmol/L with blood ketones above 3.0 mmol/L or significant ketonuria and venous pH below 7.3 or bicarbonate below 15 mmol/L.
- A near-normal glucose does not exclude ketoacidosis, particularly with an SGLT2 inhibitor, pregnancy, starvation or partial insulin treatment; assess ketones and acid–base status when the syndrome fits.
- Give 0.9% sodium chloride through the weight-, circulation- and comorbidity-adjusted local schedule, documenting reassessment because both under-resuscitation and fluid overload are dangerous.
Key red flags
Polyuria, thirst, nocturia, weight loss, dry mucosa, tachycardia and reduced skin perfusion reflect hyperglycaemia and substantial volume depletion.
Investigation priorities
Confirm ketonaemia and provide a direct hourly marker of insulin-driven biochemical recovery.
Management branches
A patient with diabetes or hyperglycaemic symptoms is acutely unwell with vomiting, dehydration, abdominal pain or abnormal breathing.
- Perform ABCDE, obtain capillary glucose and blood ketones, send a venous gas with renal profile, establish monitored venous access and record weight for the insulin calculation.
- Apply the full diagnostic triad rather than glucose alone, then assess consciousness, haemodynamics, oxygenation, pH, potassium, renal function and comorbidity for the appropriate care environment.
Key medicines
Fixed-rate intravenous human soluble insulinUse 0.1 units/kg/hour by checked intravenous infusion for standard adult DKA under the current JBDS-aligned prescription chart; use actual protocol weight rules and obtain specialist direction for exceptional circumstances.
Glucose-containing intravenous fluidAdd the concentration and rate specified by the local adult DKA chart once blood glucose is below 14 mmol/L, alongside 0.9% sodium chloride and fixed-rate insulin as fluid status permits.