As with any critically unwell patient management starts with ensuring that there is a patent airway, and ensure adequate oxygenation and ventilation. If the GCS is reduced or ventilation is impaired, this may well necessitate intubation via a rapid sequence induction. In the initial phase of resuscitation high flow oxygen through a non-rebreathing mask should be administered. Patients should be on continuous 3-lead cardiac monitoring. If there is hypotension this needs to be treated in the first instance with IV fluid resuscitation. Inotropes may be needed in septic or cardiac shock following adequate fluid resuscitation.

An adequate history must be taken and examination performed searching for the underlying cause that precipitated DKA.