What are the potential complications of DKA treatment that I should monitor for during management?

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 ¹. 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 ¹. 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 ¹. 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 ¹.
• 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 ¹.

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 ¹. 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 ¹. 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 ¹. Healthcare professionals performing monitoring must know what to look for and when to seek advice ¹.