Patient handout

Diabetic ketoacidosis

PRODUCTION

1. Your condition

This handout is for diabetic ketoacidosis. Your care team identified this based on: hyperglycemia + ketonemia + acidosis (ada 2026 §16).

Other reasons your team may use this plan: high anion-gap metabolic acidosis (ada 2026 §16); kussmaul respirations / fruity breath (kitabchi 2009); polyuria + polydipsia + weight loss (ada 2026 §16).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
0.9% sodium chloride	Adult 1.0–1.5 L IV bolus over 1h, then 250–500 mL/h; ISPAD peds 10 mL/kg over 30–60 min only if shocked, total ≤40 mL/kg first 4h	IV	continuous	ADA/EASD 2024 — restore volume + GFR; switch to ½NS if corrected Na rising; peds slower per ISPAD 2022 to limit cerebral-edema risk
dextrose 5% in 0.45% NaCl	D5 ½NS at 150–250 mL/h once glucose <200–250 mg/dL (ADA 2026 §16)	IV	continuous	Allows insulin to keep clearing ketones without iatrogenic hypoglycemia; mandatory in euglycemic / SGLT2i-DKA from outset (ADA 2026 §16)

Plan: DKA acute resuscitation — ADA/EASD 2024 5-pillar (fluids → K → insulin → bicarb → transition)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Serum K <3.3 mEq/L on initial labs (ADA 2026 §16)
Arterial/venous pH <6.9 — adult only (ADA 2026 §16)
Pediatric DKA with new headache, bradycardia, hypertension, AMS, or focal neuro signs (ISPAD 2022)(life-threatening)
Euglycemic DKA on SGLT2i (glucose <250 with AGMA + ketones; ADA 2026 §16)
DKA in pregnancy (any trimester; ADA 2026 §16)(life-threatening)
First-presentation DKA without prior diabetes diagnosis OR known T1DM <12 months from diagnosis with antibody-positive serology (ADA 2026 §14)
Documented or suspected insulin pump occlusion/site failure (rapid-onset DKA <8h since last bolus) in pump user (ADA 2026 §16)
BHB ≥3.0 + effective osmolality >320 + pH <7.30 (mixed DKA-HHS, ~30% of presentations; ADA/EASD 2024 consensus)

5. Follow-up

Endo within 1 wk, PCP within 2 wk, DSME, sick-day rules, discharge insulin plan, CGM initiation per ADA 2026, psychosocial follow-up if recurrent

6. Sources

Guideline: 2024 ADA/EASD/JBDS/AACE/DTS Consensus on Hyperglycemic Crises + ADA Standards of Care 2026 + JBDS-IP 02 (2023 update) + ISPAD 2022 Clinical Practice Consensus + ADA 2020 (insulin bolus removal)