While a patient is being treated for diabetic ketoacidosis (DKA) it is important to monitor the patient for various concerns.
The patient should either be in the ICU or on a ward where the patient can be frequently monitored.
Blood glucose should be tested hourly and serum electrolytes at least every 4 hours.
Concerns:
(1) resolution of symptoms
(2) failure of symptoms to resolve
(3) appearance of new symptoms
(4) relapse of DKA
As the patient recovers
(1) the serum beta-hydroxybutyrate should normalized
(2) the serum anion gap should narrow
(2) altered mental status due to DKA should resolve
(3) abdominal pain due to DKA should resolve
If an altered mental status does not improve, then a primary neurologic problem may be present.
If abdominal pain does not improve or gets worse, then an intra-abdominal process should be considered.
Complications that can emerge during the management phase:
(1) cerebral edema
(2) refeeding syndrome (if starvation present)
(3) progression of other underlying conditions
(4) delirium tremens or drug withdrawal
Relapse may be indicated by a rising blood glucose after the insulin infusion is stopped. This is followed by widening of the anion gap and by increasing serum beta-hydroxybutyrate levels.
