IV Determine hydration status Severe hypovolemi a Mild Dehydratio n Shock Administer 0,9% NaCl (1 L/h) Kemodyami monitoring Admister 0,9% NaCl Administer 0,9% NaCl 250-500 ml/n When serum glucose reaches 250 mg/dl, changes to 5% dextrose at ‘ 50-250 ml/h with Check electrol test urea or BUN, creatine and glucose every 2-4 hrs until stable. Afterresolution of DKA and when patitent is able to end. Initiate SC multidose insulin regmen. To transfer from IV to SC, continue IV insulin infusion for 1-2 hours after SC insulin begun to ensure adequate serum insulin levels. Insulin naive patients, start at 0,5-0,8 IU/kg per day and adjust as needed. Bicarbon pH 5,9-7,0 or serum pH <6,9 pH ≥ 50 mmol plus 10 mEq KCL in 200 ml water Potassiu 100 mmol plus 20 mEq KCL in No Repeat every 2 h until pH ≥ 7,0 Monitor Soluble insulin 0,1 IU/kg bolus IV 0,1 IU/kg/h as continuous f serum glucose doesn’t fall by at least 10% in first hour, the insulin dose should be doubled or increased by 0,05- When serum glucose reaches 250 mg/dl, reduce 250 mg/dl, reduce insulin infusion serum to 0,2-0,005 IU/kg/h Keep serum glucose between 150 and Establish adequate renal function <3,3 > Hold insulin and give 20- 30 mEq/h KCL until >3,3 Don’t give but check serum = 3,3-5,2 Give 20-30 mEq in each liter of IV fluid to keep serum between
