Excellent article on Diabetic Ketoacidosis (DKA): http://www.emedicine.com/PED/topic582.htm
- PEDS http://www.emedicine.com/med/topic548.htm
BS at near normal levels (at/about 250 and higher) indicates DKA. Pts. in DKA will be acidotic. Bicarb level(s) via ABGs is/are better indicator(s) of degree
Although showing acidosis in the above scenario, the pH is not the primary focus and not aggressively tx. Treat BS and pH (acidosis) will automatically improve. If not, may indicate inadequate tx with fluids and insulin. If evidence of ECG changes indicating cardiac contractility abnormalities secondary to acidosis, will be indication to address and tx appropriately.
Critical to address status of K+ prior to insulin administration. Never administer insulin before ascertaining the level of K+. Replace K+ if deficient for when you tx with insulin, the insulin forces K+ back into the cells and can result in hypokalemia.