Complications of diabetic ketoacidosis and its treatment

Complications of diabetic ketoacidosis and its treatment

Hypokalaemia and hyperkalaemia

• are potentially life-threatening conditions and careful management of potassium during treatment of DKA diabetic ketoacidosis is essential
• potassium should not be prescribed with the initial litre of fluid or if the serum potassium level remains above 5.5 mmol/l since severe dehydration may cause acute pre-renal failure
• treatment with fluid and insulin will almost always lead to a fall in potassium
  • 0.9% sodium chloride solution with potassium 40 mmol/l (ready-mixed) is recommended if the serum potassium level is below 5.5 mmol/l and the patient is passing urine
• if the serum potassium level falls below 3.5 mmol/ l, the potassium regimen needs review.

Hypoglycaemia

• with the correction of ketoacidosis, blood glucose levels will fall very rapidly
• if not corrected this may result in a rebound ketosis driven by counter-regulatory hormones, which can lengthen duration of treatment
• severe hypoglycaemia is associated with cardiac arrhythmias, acute brain injury and death
• once the blood glucose falls to 14 mmol /l, intravenous glucose 10% should be commenced alongside the 0.9% sodium chloride solution in order to prevent hypoglycaemia.

Cerebral oedema

• symptomatic cerebral oedema is relatively uncommon in adults treated for diabetic ketoacidosis, but asymptomatic cerebral oedema may be a relatively common occurrence
• usually occurs within a few hours of initiation of treatment

Pulmonary oedema

• rare complication of DKA
• elderly patients and those with impaired cardiac function are at particular risk and monitoring of central venous pressure should be considered

Reference:

1. Joint British Diabetes Societies for Inpatient Care. The Management of Diabetic Ketoacidosis in Adults. Revised March 2023.