Initial evaluation and treatment of DKA in the emergency department. *Laboratory studies: complete blood count, basic metabolic panel, venous blood gas, urinalysis, urine pregnancy test if female and childbearing age. If critically ill or clinically indicated: complete metabolic panel, serum osmolality, phosphate, lactate, cardiac markers, urine drug screen, blood alcohol level, chest X-ray, or other imaging studies. Calculate effective serum osmolality and corrected serum sodium. Signs of critical illness include 1) altered mental status: 2) signs of hypoperfusion; 3) significant derangement in heart rate, blood pressure, respiratory rate, temperature, or oxygen saturation; or 4) signs of severe acidosis such as marked Kussmaul respirations. BMP, basic metabolic panel; BP, blood pressure; ECG, electrocardiogram; HR, heart rate; hyperK, hyperkalemia; IVF, IV fluids; IVP, IV push; NS, normal saline; O2, oxygen; O2 sat, oxygen saturation; pt, patient; RR, respiratory rate; SC, subcutaneous; temp, temperature; VBG, venous blood glucose.
