Other Considerations

Bicarbonate [37-43]

• There is evidence that when used in DKA the risk of cerebral oedema is increased
• Do not give IV sodium bicarbonate to young people with DKA. Only consider giving bicarbonate following a discussion with intensive care, if there is life threatening hyperkalaemia or severe acidosis.

Phosphate

• Intracellular ion that is depleted during DKA (~0.5-2.5mmol/kg). [30,44]
• There is no evidence that correction improves outcome & in fact may result in hypocalcaemia. [45-49]
• Phosphate replacement may be considered if the hypophosphataemia is associated with metabolic encephalopathy, reduced myocardial contractility, or ileus.

Risk of venous thrombosis [19,22]

• Be aware there is significant risk of DVT in patients who have a femoral venous line in situ.