Diabetic ketoacidosis: effective low-cost treatment in a community hospital

Diabetic ketoacidosis can be effectively and economically treated by using low-dose intravenous insulin and 2 to 3 liters of isotonic saline at 500 ml/hr to replace extracellular fluids, followed by 2 to 4 L of 5% glucose in 0.45% saline with potassium chloride and/or potassium phosphate to replace intracellular fluids at 250 ml/hr. During the first six to nine hours serum glucose and potassium are measured every two to three hours, and bicarbonate, sodium, and chloride every four to six hours. Determination of arterial blood gas and serum ketone levels, electrocardiograms, and chest x-ray films are done only when indicated, and not routinely. Few patients need to be treated in an intensive care unit, and most can be discharged in three days. This protocol has been safe and effective without mortality in 250 consecutive patients. By eliminating unnecessary laboratory tests, costs have been greatly reduced without deterioration in results.