Diabetic ketoacidosis (peds)

Revision as of 23:39, 9 December 2014 by Rossdonaldson1 (talk | contribs) (IV Fluids)

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

  • Bolus 20ml/kg NS x 1 (repeat boluses only for shock or poor perfusion)
  • 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