A summary of fluid management:
- 0.9% NaCl (Titrated to effect)
- May initially require 1L STAT, followed by 1hr/2hr/4hr Bags (faster if clinically dehydrated)
- Only start insulin infusion immediately if there is HHS with evidence of ketones (urine ketones >2, serum 1-3) and not acidotic (pH >7.3)
- OR in a mixed DKA HHS picture i.e. significant ketones (>3)and acidotic (<7.3)
- If the osmolality is increasing and fluid balance adequate, then consider switching to 0.45% sodium chloride at same infusion rate.
Further guidance on fluid management, and specific management for certain patient groups can be found in the JBDS: The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes guideline.
