Medical

DKA / severe metabolic acidosis

Before / During / After / Pitfalls

Before

• Recognize high pre-intubation minute ventilation; the patient may be compensating for severe acidosis.
• Optimize fluids, potassium, insulin pathway, vasopressor if needed, and involve ICU/RT early.
• Plan minimal apnea and post-tube ventilation that approximates physiologic demand while respecting lung protection.

During

• Avoid prolonged paralysis/apnea; assign someone to start ventilation immediately after tube confirmation.
• Use continuous EtCO2 and rapid blood gas reassessment.
• Consider hemodynamic collapse risk from acidosis, hypovolemia, and PPV.

After

• Set RR/minute ventilation intentionally and reassess pH/CO2 quickly.
• Continue DKA resuscitation; airway does not fix the metabolic problem.
• Watch for cerebral edema risk in pediatrics and severe cases.

Pitfalls

• Routine low RR after tube leading to abrupt CO2 rise/acidemia.
• Long apnea during RSI.
• Focusing only on the tube while forgetting K/fluids/insulin physiology.