Diabetic Ketoacidosis (DKA)

Correct before elective surgery - DKA is a medical emergency — defer elective cases and resuscitate first (fluids, insulin, electrolytes). Only life-threatening surgery proceeds alongside treatment.

Volume resuscitation - These patients are profoundly dehydrated; restore intravascular volume, which also improves perfusion and helps clear ketones.

Potassium is the trap - Total-body potassium is depleted even when serum is normal or high; insulin and correction of acidosis drive it into cells — monitor and replace to avoid dangerous hypokalemia.

Glucose and insulin - Continue an insulin infusion and monitor glucose frequently; don't stop insulin abruptly, or ketogenesis resumes.

Acid-base and ventilation - Patients compensate by hyperventilating; if you ventilate, match their minute ventilation so as not to worsen the acidosis, and watch the anion gap close.

Diabetic ketoacidosis is a hyperglycemic emergency of absolute or relative insulin deficiency: without insulin, cells can't use glucose, so the body burns fat and produces ketoacids and a high-anion-gap metabolic acidosis.

Hyperglycemia drives an osmotic diuresis causing profound dehydration and total-body potassium depletion (despite a normal or high serum potassium initially). Patients are volume-depleted, acidotic, and electrolyte-deranged; elective surgery is deferred until corrected.