Diabetic Ketoacidosis Medical Slides

Potassium shifts extracellularly in DKA due to acidosis and insulin deficiency, masking a total body deficit of 3-5 mEq/kg. When insulin drives potassium intracellularly during treatment, fatal hypokalemia can develop. Teach the rule: hold insulin if potassium is below 3.3 mEq/L, replace to above 3.3 before starting, and add 20-40 mEq to each liter of fluids when potassium is 3.3-5.3.

Include a dedicated slide on SGLT2 inhibitor-associated euglycemic DKA, which presents with normal or mildly elevated glucose but significant acidosis and ketonemia. Emphasize that this diagnosis is easily missed because glucose-based screening fails, and that a high index of suspicion is needed in patients on empagliflozin, dapagliflozin, or canagliflozin.

DKA resolution requires at least two of: glucose below 200 mg/dL, serum bicarbonate at or above 15 mEq/L, venous pH above 7.3, and anion gap at or below 12. Emphasize overlapping subcutaneous insulin by 2 hours before stopping the infusion to prevent rebound ketoacidosis, as this is the most common management error.