When treating diabetic ketoacidosis, when should potassium supplementation be initiated? Insulin drip stopped? Dextrose added to the fluids?

A one minute DKA treatment primer ....

1. Rule out precipitants

2. Aggressive hydration

NS 10-14 ml/kg/hr tailored to cardiovascular status

3. Insulin

10 U IV push followed by 0.1 U/kg/h, continue drip until anion gap normal. If glucose < 250 and anion gap still high, add dextrose to IV fluid and continue the insulin drip. Once anion gap normal, transition to SC insulin.

4. Electrolyte repletion

Potassium: add 20-40 mEQ/L IV fluid if serum K < 4.5, cautious K repletion recommended in those with renal failure

Phosphate: replete if < 1


Source

Sabatine, M. MD. Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine. 3rd edition