{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"DKA- Fluids, Potassium and Insulin.","description":"Diabetic ketoacidosis (DKA) is not just \u201chigh blood sugar\u201d \u2014 it\u2019s a hormonal storm caused by absolute insulin deficiency and a surge of counter-regulatory hormones. The result is a triad of hyperglycaemia, dehydration, and metabolic acidosis. We follow Sophie, a 23-year-old with type 1 diabetes who arrives with vomiting, Kussmaul breathing, glucose 28 mmol\/L, ketones 5.6 mmol\/L, and pH 7.08. \ud83d\udd0d What\u2019s Going Wrong? No insulin \u2192 cells can\u2019t use glucose \u2192 liver produces more. Glucose spills into urine \u2192 osmotic diuresis \u2192 6\u20138L fluid + electrolyte loss. Fat breakdown produces ketones \u2192 metabolic acidosis. Potassium appears normal or high, but total body stores are low. \ud83d\udc89 Treatment Logic (Always in This Order): Fluids first \u2013 1L 0.9% NaCl over 30 mins (slower if frail\/cardiac issues). Restores perfusion, lowers stress hormones. Potassium next \u2013 replace before insulin if K\u207a <3.5 mmol\/L; add to fluids if 3.5\u20135.5. Insulin third \u2013 fixed-rate 0.1 units\/kg\/h to stop ketone production, not to chase glucose. Add 10% dextrose when glucose falls to ~14 mmol\/L to safely continue insulin. Treat the trigger \u2013 infection, missed insulin, MI, etc. \u2705 Key Message DKA isn\u2019t chaotic when understood physiologically. Fluids, potassium, insulin \u2014 in that order. You\u2019re not treating the number; you\u2019re fixing the metabolic storm. ","author_name":"The Critical Care Practitioner","author_url":"http:\/\/criticalcarepractitioner.libsyn.com\/website","html":"