Complications

Complications table
ComplicationTimeframeLikelihood

hypokalaemia

short termhigh

This iatrogenic complication can occur with excessive high-dose insulin therapy and bicarbonate therapy. It can be prevented by following current treatment protocols with frequent monitoring of potassium levels and appropriate replacement.[1][198][199]

hypoglycaemia

short termmedium

This iatrogenic complication can occur with excessive high-dose insulin therapy. It can be prevented by following current treatment protocols with frequent monitoring of plasma glucose and use of glucose-containing intravenous fluids.[1]

arterial or venous thromboembolic events

short termmedium

Standard prophylactic low-dose heparin is certainly reasonable in these patients.[1][45][200] Applying prophylactic treatment is based on clinical evaluation by the physician of risk factors for thromboembolic events. Currently no evidence exists for full anticoagulation.

cerebral oedema/brain injury

short termlow

Assess Glasgow Coma Scale hourly to monitor for cerebral oedema.[42]

  • Other features of cerebral oedema are recurrent vomiting, incontinence, irritability, abnormal respirations, and cranial nerve dysfunction. These usually occur several hours after starting treatment.[42][61]

  • If you suspect cerebral oedema, seek immediate senior and critical care support.

    • Give mannitol.[62]

    • Consider ordering a CT head if the Glasgow Coma Scale score is deteriorating or the patient has a new or worsening headache.[137]

The exact cause of cerebral oedema is unknown. It occurs most commonly in children and adolescents, and is rare over the age of 28. It is the most common cause of mortality in DKA.[42][61][2]

pulmonary oedema/acute respiratory distress syndrome (ARDS)

short termlow

Pulmonary oedema and acute respiratory distress syndrome (ARDS) are rare but significant complications of treatment for DKA and present with fluid overload and low oxygen saturations.[138]

  • They occur when excess fluid is given, even in patients with normal cardiac function.

  • They are more common in patients who are severely dehydrated or with higher glucose levels on arrival.

  • Look for an increased alveolar to oxygen gradient (AaO2) and auscultate for lung crepitations.

  • Request a chest x-ray if oxygen saturations fall. Consider performing an arterial blood gas.

Pulmonary oedema typically occurs several hours after treatment is started and can occur even in patients with normal cardiac function.[42][17]

non-anion gap hyperchloraemic acidosis

short termlow

This occurs due to urinary loss of ketoanions needed for bicarbonate regeneration, and also increased reabsorption of chloride secondary to intensive administration of chloride-containing fluids. This acidosis usually resolves and should not affect the treatment. It is more likely in pregnant women.[1][199]

Use of this content is subject to our disclaimer