DKA management requires simultaneous fluid resuscitation, gradual hyperglycemia correction, suppression of lipolysis/ketogenesis with insulin, and vigilant electrolyte management.
Check K+ before insulin! If K+ < 3.3 mEq/L, HOLD insulin and replete K+ first to avoid fatal arrhythmias.
Continuous IV regular insulin infusion (0.1 units/kg/h); switch to subQ only once anion gap closes and patient tolerates oral intake.
If patient has severe gastroparesis, abdominal distension, or altered consciousness to prevent aspiration.
Add 5% Dextrose to IV fluids once blood glucose reaches 200-250 mg/dL to prevent cerebral edema while insulin continues closing the anion gap.
Monitor renal function and urine output (>0.5 mL/kg/h) to assess perfusion and guide potassium repletion.
Isotonic 0.9% NaCl (1-1.5 L in the first hour) to expand intravascular volume and improve tissue perfusion.
Identify and treat precipitating causes: Infection (most common), Infarction, Non-compliance, Pregnancy.