FIELD REFERENCE
Full criteria & treatment guidance
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.
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
- A glucose of 400 mg/dL or higher requires 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. Glucose below 250 follows one pathway; glucose above 250 but below 400 also requires the 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 make a BLS decision from one glucose value alone, especially at a boundary the standing order does not clearly address.
- Document serial findings and the full rationale for the chosen level of transport.
UNDERSTAND THE CARE
Why glucose alone cannot determine transport level
The number is one part of the local decision. The suspected DKA branch combines hyperglycemia with concerning symptoms or physiology, including altered consciousness or labored breathing. Infection, vomiting and significant comorbidity can change the interpretation of a value that might otherwise appear less urgent.
Applying the guidance
When BLS transport is being considered, verify every relevant clinical requirement rather than using the glucose value as a shortcut. Document mental status, vital signs, oxygenation, other complaints and comorbidity. Supportive fluids still require assessment for overload and reassessment of perfusion. This order does not supply a field insulin regimen.
Putting it together
Teaching example: glucose is below 400 but the patient is lethargic with deep labored breathing. Use the full suspected-DKA and ALS criteria; do not select BLS from the number alone.
Diagram text & teaching checkpoints
- Glucose
- Record the value and time.
- Clinical findings
- Mental status, breathing and perfusion.
- Context
- Infection, vomiting and comorbidity.
- Transport
- Match the complete criteria, not one number.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.