Diabetic ketoacidosis (peds)

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

• Cerebral Edema in DKA

See Also

Diabetic Ketoacidosis (DKA)

Source

Tintinalli