The DKA on the pump

24F in DKA on a fixed-rate insulin infusion (bed 2), handing over to the night.

Select the 5 lines the night team actually needs, then commit.

• DKA from a missed pump day: pH 7.19 at 14:00, now 7.31; ketones 4.8 down to 1.9; on fixed-rate insulin at 0.1 units/kg/hr.
• Hourly glucose and 2-hourly ketones and gas; when glucose falls under 14, add 10 percent dextrose alongside the infusion, do not stop the insulin.
• Potassium 3.8 at 16:00 with 40 mmol in the current bag; recheck at 20:00, and if under 3.5 call for a replacement plan before the next bag.
• Exit criteria: ketones under 0.6 and pH over 7.3 with the patient eating: then switch to subcutaneous insulin with the pump team, giving the first dose BEFORE stopping the infusion.
• She is anxious about her pump and has her own supplies; diabetes specialist nurse will see her in the morning.
• Her HbA1c last month was 88.
• If she spikes a temperature, culture and examine for the precipitant we have not found.
• She is a veterinary student and asked good questions about ketones.
• Mum is listed as next of kin and visited earlier.
• Consider stepping down to the ward from the monitored bay if stable at midnight.