Diabetic ketoacidosis in a young person — fluids, insulin and potassium

Presentation

A 23-year-old woman with known type 1 diabetes is brought to the emergency department by her flatmates, who describe three days of a flu-like illness, vomiting and increasing thirst and polyuria, and then a day of progressive drowsiness. On arrival she is drowsy and hyperventilating (respiratory rate 32, deep sighing breaths), dehydrated, with a heart rate of 120, blood pressure 100/60, and the smell of ketones on her breath.

Her glucose is 32 mmol/L, her blood ketones (β-hydroxybutyrate) are 6.2 mmol/L, and her blood gas shows a high anion-gap metabolic acidosis (pH 7.18, HCO3 9, anion gap 26). Her potassium is 5.0 mmol/L and her sodium 130.^[1]