Observations and Monitoring

DKA may be precipitated by sepsis or intercurrent infection. Fever is not part of DKA. Suspect sepsis if there is fever or hypothermia, hypotension, refractory acidosis or lactic acidosis.

• Hourly
  • Neurological & basic observations
    • NB: Half-hourly neurological observations should be employed in children under 2 years and/or those with severe DKA (increased risk of cerebral oedema)
  • Strict fluid balance
  • Capillary blood glucose and ketones
    • Urine ketones can be used if blood testing not available
• Medical review, venous blood gases, U&Es and glucose
  • Check 2 hours after management commenced
  • Then at least 4 hourly
• Medical staff should be informed immediately if:
  • Headache, change in CGS or behaviour
  • Slowing of pulse, changes in the ECG trace (especially T wave changes)

Fig 3: Young people with DKA should be monitored regularly during their treatment