A fictional 27-year-old with type 1 diabetes presents with vomiting, abdominal pain, deep breathing and rising capillary ketones after an intercurrent illness.
Frame the danger first.
- Confirm the biochemical pattern using ketones, venous pH or bicarbonate, and glucose or known diabetes.
- Remember that DKA can occur with a relatively modest glucose, including with SGLT2 inhibitor exposure.
- Assess severity, dehydration, potassium risk and the precipitating cause together.
Act, escalate, reassess.
- Use the current JBDS/local adult DKA pathway and involve the diabetes team early.
- Restore circulating volume and commence protocol-directed insulin and electrolyte management with appropriate monitoring.
- Track ketone clearance, acid-base recovery, glucose, potassium, renal function and clinical response.
- Identify infection, missed insulin, infarction, medicines or another precipitant and plan safe transition only after resolution.
Red flags that change pace.
- Shock, reduced consciousness, severe acidosis or major potassium abnormality
- Failure of ketones or acidosis to improve as expected
- Pregnancy, significant cardiac/renal disease or concern about cerebral oedema
What makes care less safe.
- Using glucose alone to diagnose or declare resolution
- Stopping background long-acting insulin without a clear protocol reason
- Replacing fluid or potassium without accounting for comorbidity and serial results
Say the concern plainly.
DKA with ketones [result/trend], pH/bicarbonate [result/trend], glucose [result] and potassium [result]. Current protocol stage is [stage]; response is [summary]. The likely precipitant is [known/uncertain], and I need help with [severity/non-response/comorbidity].