Initially, it is important to correct the fluid loss incurred in DKA. Fluid resuscitation is a large part of DKA treatment because it replenishes intra- and extravascular fluid loss, while replacing lost electrolytes.
Regular insulin drip should be started initially, as well, as DKA was caused by a deficiency of it. This helps to correct hyperglycemia and to decrease ketone formation. It should be noted not to over-administer insulin and cause hypoglycemia.
In DKA, serum potassium is high due to a shift, and total body potassium is actually depleted. Thus, after initial treatment, it is important to monitor and administer potassium as needed.
At this point in treatment, patients have been stabilized and given insulin. It is important to monitor patient glucose levels and administer to maintain a healthy level; this is because insulin may cause the patient to become hypoglycemic.
DKA can be caused by a precipitating factor or incident (infection, stress) which leads to the antagonism of insulin. Thus, many times along with stabilizing the patient, infection, stress, etc. need to be treated as well.
Venous pH is monitored in patients, in order to see if their acidosis has been corrected.
Serum bicarbonate levels are monitored, but not typically replaced, as they will improve with stabilizing and other treatments for DKA. In life-threatening acidosis, replacement bicarbonate may be given, but with the caveats of possible cerebral edema and paradoxical acidosis.
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