Other aspects of managing ketoacidosis

1. Seek a precipitating cause and treat as indicated. Approximately 50% are related to underlying disease, e.g. sepsis, myocardial infarction, stroke, infective gastroenteritis.

2. Only give antibiotics for proved or highly suspected infection.

3. Abdominal pain should not be dismissed as part of the syndrome.

4. A nasogastric tube should be inserted, as gastric emptying is often delayed and acute gastric dilatation is common.

5. Avoid bicarbonate, even for severe acidosis (pH <7.0). It causes an increased intracellular acidosis and

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depressed respiration due to a relative CSF alkalosis. Sodium overload may also occur. 6. Low molecular weight heparin 5000U SC od is indicated in immobile or comatose patients.

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