This will not occur in isolation of other factors that herald in-hospital cardiac arrest. Most likely it will be associated with hypoxia and / or hypercarbia.


A metabolic acidosis is commonly seen with diabetic ketoacidosis. DKA has not been identified as an independant high risk factor for in-hospital cardiac arrest. The principles of treatment of DKA are:

GIVE high concentration oxygen

MONITOR SpO2, ECG, BP, hourly urine output

TAKE blood for FBC, U&E, arterial blood gases

CONSIDER trigger causes (MI, infection, profound renal failure)

CAUTION if renal failure suspected seek expert advice

START intravenous fluids eg sodium chloride, first 1L rapid IV, then 500ml per hour for 3 hours (guidance only)

GIVE actrapid insulin infusion 6iu/hr until glucose <14mmol/L then reduce to 3iu/hour

CONTINUE IV fluids with added potassium while monitoring ABGs and potassium: acidosis often responds to fluid replacement


     K+ replacement

> 6.0
4.6 - 5.9
3.5 - 4.5
< 3.5

No added K+
Add 1g KCI per hour
Add 1g KCI per hour
Add 1g KCI per hour

CONSIDER 100mmol sodium bicarbonate if pH < 6.9, but ensure adequate fluid resuscitation in progress first


 100 mls 8.4% over 30 mins via central line OR
400 mls 2.1% over 30 mins via peripheral line

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