Diabetic Ketoacidosis: Complications of Treatment

Key points

• Complications of DKA and its treatment.
• Gastric stasis (aspiration risk) — consider a nasogastric tube if the patient is drowsy or vomiting.
• Venous thromboembolism — give prophylactic low-molecular-weight heparin.
• Arrhythmias from hyperkalaemia (at presentation) or iatrogenic hypokalaemia (during insulin therapy) — monitor potassium and replace once it falls below 5.5 mmol/L.
• Iatrogenic complications: cerebral oedema (especially children/young adults — monitor conscious level; treat with hypertonic saline or mannitol), hypokalaemia, hypoglycaemia, and fluid overload/ARDS. JBDS treatment: fixed-rate IV insulin 0.1 units/kg/hour, IV 0.9% sodium chloride, potassium replacement, and CONTINUE the usual long-acting (basal) insulin.