During the management of diabetic ketoacidosis (DKA) treatment, it is crucial to monitor for specific potential complications:
- Cerebral Oedema: This is a primary complication to monitor for NICE NG18. Immediate assessment for suspected cerebral oedema is required if early manifestations such as headache, agitation or irritability, an unexpected fall in heart rate, or increased blood pressure are observed NICE NG18. Treatment for cerebral oedema should be started immediately if these signs are present, or if there is a deterioration in the level of consciousness, abnormalities of breathing pattern (e.g., respiratory pauses), oculomotor palsies, or pupillary inequality or dilatation NICE NG18. The level of consciousness should be monitored using the modified Glasgow Coma Scale, at least hourly, and every 30 minutes in children under 2 years or those with severe DKA (blood pH below 7.1) due to their increased risk of cerebral oedema NICE NG18.
- Hypokalaemia: During intravenous therapy for DKA, continuous electrocardiogram (ECG) monitoring should be used to detect signs of hypokalaemia, such as ST-segment depression and prominent U-waves NICE NG18.
General monitoring is essential to detect these and other issues during DKA management. This includes monitoring and recording at least hourly: capillary blood glucose, heart rate, blood pressure, temperature, respiratory rate (looking for Kussmaul breathing), fluid balance (with input and output charts), and level of consciousness NICE NG18. Blood tests, including laboratory glucose, blood pH and pCO2, plasma sodium, potassium, and urea, and beta-hydroxybutyrate, should be carried out and recorded at 2 hours after starting treatment and then at least every 4 hours NICE NG18. A doctor should review the patient face-to-face at diagnosis and at least every 4 hours, or more frequently if there are specific concerns, assessing clinical status, blood investigation results, ECG trace, and cumulative fluid balance record NICE NG18. Healthcare professionals performing monitoring must know what to look for and when to seek advice NICE NG18.