Diabetic Ketoacidosis Action Sheet

Patient Information

Name

MRN

Date of Birth

Date

Diagnosis Criteria

Blood Glucose >
pH <
Bicarbonate <
Ketonemia/Ketonuria present

DKA Severity

	Mild	Moderate	Severe
pH
Bicarbonate
Mental State

Initial Assessment

Airway/Breathing/Circulation
Vital Signs
Glasgow Coma Scale
Capillary Blood Glucose
Blood Ketones
Urinalysis
Electrolytes, Renal function
Venous/Arterial Blood Gas

Immediate Management

Oxygen
IV Access
Fluid Resuscitation: ml/kg/hr
Potassium Replacement
IV Insulin infusion: units/hr
Monitor for complications

Monitoring/Observations

Parameter	Frequency	Target/Comment
Blood Glucose
Ketones
Vital Signs
Electrolytes
Mental Status

Notes / Further Actions

Responsible Clinician

Name

Signature

Date/Time