As a result, the diagnosis of DKA may be delayed. Therefore, appropriate emergency management of DKA includes aggressive fluid resuscitation. Fluid rate should be adjusted based on urine output and vital signs. Aggressive correction of dehydration may be associated with cerebral edema and therefore necessitates continuous monitoring of the neurologic state. This is true even though initial serum measurements may be normal.
Sodium is replaced with appropriate rehydration.
Potassium may also be lost through hyperaldosteronism due to dehydration, intracellular influx caused by simultaneous administration of glucose and insulin, and aggressive correction of metabolic acidosis. Potassium supplementation should be initiated after the initial fluid bolus, when the urine output is established and a baseline serum level is obtained. In DKA, there are also substantial renal losses of phosphate, which may exacerbate resistance to insulin. This replenishes phosphate stores and reduces the likelihood of chloride overload with fluid therapy, which may exacerbate metabolic acidosis. Serum electrolyte levels must be monitored frequently until the patient is stabilized.