Management of diabetic ketoacidosis

Many aspects of DKA treatment have become dogma without benefit of critical randomized prospective studies. Although recommendations for low-dose insulin therapy have passed the test of working in practice, many facets of treatment such as bicarbonate vs. no bicarbonate, phosphate replenishment, the merits of rapid vs. slow correction of hyperglycemia and acidosis need to be prospectively studied. In the final analysis, while insulin, fluid, and electrolyte administration are all important in the treatment of DKA, success most often hinges on careful hour-by-hour monitoring of the patient by a concerned and knowledgeable physician.