Diabetic ketoacidosis (peds): Difference between revisions
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==Background== | ==Background== | ||
*DKA + AMS = cerebral edema until proven otherwise | |||
==Diagnosis== | ==Diagnosis== | ||
*Hyperglycemia (>200) | *Hyperglycemia (>200) | ||
*Acidosis | *Acidosis | ||
**pH < | **pH <=7.30 or bicarb <=15 | ||
*+ ketonemia (>1:2 serum dilution) | *+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== | ==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 | ||
Line 25: | Line 39: | ||
**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
- 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 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
- if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
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
- Only consider for:
Disposion
- Admit all unless
- Known diabetes
- pH >7.35 and bicarb >20
- Known and resolving precipitant for DKA
Complications
See Also
Source
Tintinalli