2017
DOI: 10.3389/fendo.2017.00106
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Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols

Abstract: BackgroundDiabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs).ObjectiveTo review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management protocols and impact of DKA resolution rates on outcomes.MethodsOvid M… Show more

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Cited by 77 publications
(68 citation statements)
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“…The optimal choice of intravenous resuscitation fluid in the management of DKA still remains to be determined. Crystalloids are favoured over colloids however evidence is lacking . Traditionally, 0.9% sodium chloride is first‐line treatment due to its efficacy, safety, cost and availability; and its ability to be readily mixed with potassium.…”
Section: Discussionmentioning
confidence: 99%
“…The optimal choice of intravenous resuscitation fluid in the management of DKA still remains to be determined. Crystalloids are favoured over colloids however evidence is lacking . Traditionally, 0.9% sodium chloride is first‐line treatment due to its efficacy, safety, cost and availability; and its ability to be readily mixed with potassium.…”
Section: Discussionmentioning
confidence: 99%
“…Specifically, the ADA recommends 1000-1500 mL and the UK guideline recommends 1000 mL of normal saline during the first hour. Although normal saline contains a supraphysiologic concentration of chloride potentially leading to hyperchloremic metabolic acidosis, as discussed in the complications section of this review, insufficient evidence exists to support the hypothesis that balanced electrolyte solutions improve time to resolution of diabetic ketoacidosis or prevent major adverse kidney events in this population 60. The UK guideline acknowledges this and includes a statement that balanced electrolyte solutions can be used, but as they are not commercially available with premixed potassium chloride, they must be used in conjunction with additional potassium replacement 2…”
Section: Acute Managementmentioning
confidence: 98%
“…By contrast, the UK guideline recommends 40 mmol/L in each liter of normal saline when serum potassium is below 5.5 mmol/L and the patient is passing urine 2. As existing published trials evaluating potassium replacement rates were not designed to determine optimal potassium replacement rates in patients with diabetic ketoacidosis, evidence is lacking to support either recommendation over the other 60. Because insulin therapy promotes an intracellular shift of potassium, it is recommended that insulin should not be started if the serum potassium is below 3 mmol/L to avoid worsening of hypokalemia.…”
Section: Acute Managementmentioning
confidence: 99%
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