Treatment of diabetic ketoacidosis in pregnant patients

DKA: diabetic ketoacidosis; IV: intravenous; NaCl: sodium chloride; SC: subcutaneous; Na: sodium; NaHCO₃: sodium bicarbonate; H₂O: water; KCl: potassium chloride; HCO₃: bicarbonate; K: potassium; BUN: blood urea nitrogen.

* After history and physical examination, obtain capillary glucose and serum or urine ketones. Begin 1 L of 0.9% NaCl over 1 hour, and draw arterial blood gas (or mixed venous blood gas), complete blood count with differential, urinalysis, serum glucose, BUN, electrolytes, chemistry profile, and creatinine levels STAT. Obtain electrocardiogram and, if needed, chest radiograph and specimens for bacterial cultures.

¶ If initial serum K is <3.3 mEq/L, hold insulin and give KCl until K is >3.3 mEq/L.

Δ Serum Na+ should be corrected for hyperglycemia (for each 100 mg/dL glucose >100 mg/dL, add 2 mEq to sodium value for corrected serum sodium value).

◊ 100 mmol NaHCO₃ = 100 mEq NaHCO₃.

§ DKA is considered resolved when the anion gap and serum beta-hydroxybutyrate (if available) is normalized and the patient is alert and able to eat.

¥ This is an UpToDate clinical suggestion.