Diabetic ketoacidosis is a life threatening condition caused by insulin deprivation or inadequate use of insulin in people with type 1 (or occasionally type 2) diabetes mellitus. Precipitants include deliberate insulin omission, intercurrent illness, surgery, trauma, alcohol, late presentation of previously undetected type 1 diabetes, and the use of drugs that alter carbohydrate metabolism.1 People with diabetic ketoacidosis need swift intervention by specialists because of the substantial morbidity and mortality arising from the acid-base imbalance, profound fluid loss, and electrolyte disturbances.

Current guidelines written by diabetes specialists from the United States and the United Kingdom recommend initial replacement of fluids and electrolytes and intravenous insulin.1 2 The fluid advocated in these guidelines is 0.9% saline. However, people may be treated by emergency and intensive care doctors as well as diabetes specialists, and the type of fluid used can vary.

During the first few hours of hospital …