Diabetic ketoacidosis (peds): Difference between revisions
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Revision as of 06:48, 6 June 2011
Treatment
- IV Fluids
- Bolus 20ml/kg NS prn unstable VS
- NS@10ml/hr/kg for stable VS
- Replace fluid deficit evenly over 48hrs w/NS or ½NS
- When BS < 250, go to #5 below
- Insulin
- IV Infusion 0.1 units/kg/hr
- Cont until HCO3>p15 and pH>7.3
- Decrease infusion to 0.05 u/kg/hr until SC insulin initiated
- IV Infusion 0.1 units/kg/hr
- Potassium
- if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
- No insulin until K > 2.5
- if > 2.5 but < 3.5, then give 40-60 meq/L in IV until K > 3.5
- if > 3.5 but < 5.5, then give 30-40 meq/L in IV for K=3.5 - 5
- if > 5.5, then check K q1hr
- if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
- Bicarbonate
- if pH < 7.0 after 1hr fluids, then give 2 meq/kg NaHCO3 in NS x1hr
- (don't exceed 155 meq/L Na)
- if pH < 7.0 after 1hr fluids, then give 2 meq/kg NaHCO3 in NS x1hr
When BS < 250
- Change fluid to D5½NS @ rate to correct fluid deficit in 48hrs and maintain BS 150-250 (may require D10 w/lytes)
- Check chem7 q2hrs until gap closes
Source
Adapted from Pani