# Adult hyperglycemia / suspected DKA

Use glucose together with mental status, breathing, vital signs, and comorbidity to choose support and transport.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/hyperglycemia/
Official source: [SO-M-010 — Hyperglycemia - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/import/data/files/102906.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- This adult/adolescent order is not a pediatric DKA fluid protocol.
- Do not treat a normal-looking glucose threshold as a substitute for assessment of breathing or perfusion.

## Source documents

- [SO-M-010 — Hyperglycemia - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/import/data/files/102906.pdf)

## Assess more than the glucose

- Measure and document glucose, mental status, vital signs, oxygen saturation, hydration, and associated symptoms. Deep labored breathing may be Kussmaul respirations.
- Look for fever/infection, vomiting, abdominal pain, and significant comorbidity. Consider sepsis as a cause or coexisting problem.

## Recognize the ALS / suspected DKA branch

- At glucose at least 400 mg/dL, the source directs ALS transport.
- At glucose above 250 with confusion/lethargy, heart rate above 120, respiratory rate above 20 with labored breathing, fever history, or SpO₂ below 94%, transport ALS and consider DKA.

## Supportive care

- For the suspected DKA branch, provide oxygen as tolerated, monitor the rhythm, and establish IV access.
- Without evidence of fluid overload, give normal saline 250 mL IV and reassess; may repeat to a maximum 1 L for adequate perfusion. Consider ETCO₂ assessment for acidosis. No insulin administration regimen is provided in this field order.

## Lower-acuity transport criteria

- BLS consideration requires normal mental status, vital signs, and pulse oximetry and no other complaint requiring ALS. The source separates glucose below 250 from glucose above 250 but below 400; the latter also requires absence of relevant comorbidity.
- Consider ALS with active cancer, renal failure, liver disease, immunosuppression, abdominal pain with vomiting, CHF, organ transplant, or frailty. Do not infer a BLS decision solely from one glucose value or a boundary not explicitly addressed in the source.
- Document serial findings and the full rationale for the chosen level of transport.