Complication |
Association |
Treatment |
Hypokalemia |
Inadequate potassium replacement and ongoing potassium losses |
Increase potassium replacement; may require concentrated potassium infusion at 0.1–0.3 mEq/kg/h |
Hyperkalemia |
Generally secondary to intracellular to extracellular shift; infrequently renal failure |
Reduce/eliminate potassium in intravenous fluids; continuous renal replacement therapy as necessary |
Hypophosphatemia |
Renal losses |
Will normalize with re-establishment of nutritional support Severe hypophosphatemia should be treated |
Hypoglycemia |
Failure to add glucose to intravenous fluids when serum glucose declines below 300 mg/dl |
Addition of 5–12.5% dextrose to intravenous fluids when serum glucose declines below 300 mg/dl |
Disseminated intravascular coagulation |
Infection, tissue necrosis |
Monitor for infection and thrombosis |
Central venous thrombosis or stroke54,65 |
Prolonged dehydration; DKA represents a hypercoagulable state |
Avoid central venous catheterization, if occurs with CVC anticoagulate66 |
Dural sinus, basilar artery thrombosis or stroke67,68 |
Prolonged dehydration; DKA represents a hypercoagulable state69 |
If underlying coagulopathy suspected, anticoagulate70,71 |
Sepsis |
Impaired immunity associated with poorly controlled diabetes mellitus Antecedent for DKA |
Antimicrobials |
Mucormycosis72 |
Infection specifically associated with DKA, especially rhinocerebral or pulmonary infections |
Infectious disease, otolaryngology consultations Caspofungin, liposomal amphotericin B73 |
Rhabdomyolysis74 |
Hypophosphatemia, anemia, thrombocytopenia High osmolality on admission, more frequent in the hyperglycemic hyperosmolar state |
Preserve good renal blood flow |
Pancreatitis75,76 |
Associated with abdominal pain, but not always; often associated with elevated BUN |
Chemical pancreatitis is common in DKA, but clinical pancreatitis is rare Check amylase, lipase, lipids and calcium levels |
Hyperglycemic Hyperosmolar syndrome |
Higher risk of thrombosis, rhabdomyolysis, malignant hyperthermia and cerebral edema |
Generally requires more careful and individualized fluid therapy, careful sodium, potassium and GCS monitoring Insulin at 0.05–0.1 units/kg/h |
Hyperchloremic metabolic acidosis |
Large volume resuscitation with normal saline |
Use potassium as potassium acetate and potassium phosphate to replace potassium |
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