Diabetic ketoacidosis (peds)

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
• 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
• Bicarbonate
  • if pH < 7.0 after 1hr fluids, then give 2 meq/kg NaHCO3 in NS x1hr
    • (don't exceed 155 meq/L Na)

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