Diabetic ketoacidosis (peds)

Treatment

1) 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

2) 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

3) 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

4) Bicarbonate

     if pH < 7.0 after 1hr fluids, then

     give 2 meq/kg NaHCO3 in NS x1hr

     (don't exceed 155 meq/L Na)

5) 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