Hyperglycemia associated with DKA causes a osmotic diuresis, which presents as polyuria.

Hyperglycemia and polyuria leads to dehydration, which causes polydipsia.

Adolf Kussmaul described the typical breathing pattern of a patient in DKA. This is a deep and labored breathing pattern associated with metabolic acidosis.

First step is obtaining IV access, preferably two large bore IV lines.

Order these:
BMP
CBC
Serum Ketones
VBG (or ABG)
Fingerstick Glucose
EKG
Urinalysis
Serum Osm

Look for underlying cause..
Consider infectious dx workup

- Isotonic saline (0.9%)
- Bolus 20 mL/kg over first hour
- Post bolus maintenance infusion rate of 250 - 500 mL/hr, type of fluid determined by Na
- Find the corrected Na value
(http://www.uptodate.com/contents/calculator-plasma-sodium-concentration-cor...)
- If Na - If Na > 135, use 0.45% NaCl

- If K > 5.3 mEq/L, don't need K
- If K 3.3 - 5.3, add 20-40 mEq/L to each L of saline
- If K

- Use of bicarbonate is controversial
-Consensus is no

See link for more details
http://rebelem.com/benefit-sodium-bicarbonate-dka/

Without an insulin bolus
- Start insulin drip after NS bolus
- Rate of 0.14 U/kg per hour

Controversy over bolusing? In general, don't use.
http://rebelem.com/benefit-initial-insulin-bolus-diabetic-ketoacidosis/

- Switch to D5/NaCl + K when serum glucose reaches 200 - 300 mg/dL
-This prevents hypoglycemia

- IV insulin infusion should be continued until Glu

AND 2 of the following:
- Anion Gap - Venous pH > 7.3
- Serum bicarb > 15 mEq/L