Difference between revisions of "Diabetic ketoacidosis (peds)"

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==Background==
 
==Background==
 +
*DKA + AMS = cerebral edema until proven otherwise
  
 
==Diagnosis==
 
==Diagnosis==
 
*Hyperglycemia (>200)
 
*Hyperglycemia (>200)
 
*Acidosis
 
*Acidosis
**pH <7.25-7.30 or bicarb <15
+
**pH <=7.30 or bicarb <=15
*+ ketonemia (>1:2 serum dilution)
+
*+ketonemia (>1:2 serum dilution)
*DKA + AMS = cerebral edema until proven otherwise
+
 
 +
==Workup==
 +
*Point of care glucose (and potassium, if available)
 +
*CBC
 +
*Chem 7
 +
*Magnesium
 +
*Phosphorus
 +
*Serum ketones (or beta-OH and acetone)
 +
*UA
 +
*Urine pregnancy (if appropriate)
 +
*VBG
 +
*Consider studies for possible infectious trigger
  
 
==General Treatment==
 
==General Treatment==
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**When BS <250:
 
**When BS <250:
 
***Change fluid to D51/2NS @ rate to correct fluid deficit in 48hr; maintain BS 150-250
 
***Change fluid to D51/2NS @ rate to correct fluid deficit in 48hr; maintain BS 150-250
 +
 
===Insulin===
 
===Insulin===
 
**IV Infusion 0.1 units/kg/hr
 
**IV Infusion 0.1 units/kg/hr
 
***Cont until HCO3 > 15 and pH>7.3
 
***Cont until HCO3 > 15 and pH>7.3
 
**Decrease infusion to 0.05 u/kg/hr until 1hr after SC insulin initiated
 
**Decrease infusion to 0.05 u/kg/hr until 1hr after SC insulin initiated
 +
 
===Potassium===
 
===Potassium===
 
**if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
 
**if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
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**if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
 
**if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
 
**if >  5.5, then check K q1hr
 
**if >  5.5, then check K q1hr
 +
 
===Bicarbonate===
 
===Bicarbonate===
 
**Only consider for:
 
**Only consider for:

Revision as of 19:55, 9 December 2014

Background

  • DKA + AMS = cerebral edema until proven otherwise

Diagnosis

  • Hyperglycemia (>200)
  • Acidosis
    • pH <=7.30 or bicarb <=15
  • +ketonemia (>1:2 serum dilution)

Workup

  • Point of care glucose (and potassium, if available)
  • CBC
  • Chem 7
  • Magnesium
  • Phosphorus
  • Serum ketones (or beta-OH and acetone)
  • UA
  • Urine pregnancy (if appropriate)
  • VBG
  • Consider studies for possible infectious trigger

General Treatment

IV Fluids

    • NS @ 10ml/hr/kg for stable VS
    • Bolus 20ml/kg NS only for unstable VS
    • Replace fluid deficit evenly over 48hr w/ NS or 1/2 NS
    • When BS <250:
      • Change fluid to D51/2NS @ rate to correct fluid deficit in 48hr; maintain BS 150-250

Insulin

    • IV Infusion 0.1 units/kg/hr
      • Cont until HCO3 > 15 and pH>7.3
    • Decrease infusion to 0.05 u/kg/hr until 1hr after 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 give 40-60 meq/L in IV until K > 3.5
    • if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
    • if > 5.5, then check K q1hr

Bicarbonate

    • Only consider for:
      • Critically ill (hemodynamic compromise from decr contractility) AND
      • pH <7.0
    • 0.5-2 mEq/kg over 1-2hr
    • Correction should never exceed pH > 7.1 or bicarb >10

Disposion

  • Admit all unless
    • Known diabetes
    • pH >7.35 and bicarb >20
    • Known and resolving precipitant for DKA

Complications

See Also

Diabetic Ketoacidosis (DKA)

Source

Tintinalli