Management of DKA

Tx
H20

Use:
- weight loss (% body
weight)
- HR
- BP
- cap refill
- skin turgor

Fluid push = 10ml/kg

- immediately to help cardiac output
To replace 10% weight loss in a 20kg child, give 2L
of fluid (water = 1kg/L)

4-2-1 rule for maintenance:

4mL/kg/h for 1st 10 kg
Do not use:
2ml/kg/h for next 10 kg
- urine output (polyuria ->
1ml/kg/h for the rest
will pee out every last drop) (x24 per day)
Overall = (Replacement + Maintenance - Fluid
push)/time period = __ mL/h
Na

- low

Normal saline (at the rate calculated above)

- serum K+ is usu. normal

but total body K+ is very
low

40 mEq/L KCl (more may be painful)

Insulin

- low

Start 1-2h after administering fluids

(giving insulin immediately may cause cerebral
edema)

Glucose

Give glucose when insulin kicks in to prevent

hypoglycemia

Fix
acidosis

Lactic acidosis: treat with fluids

Ketoacidosis: treat with insulin
DO NOT GIVE BICARBONATE!

Monitor Na, K, Cl, HCO3, anion gap q3h, cap pH, pCO2, base deficit, urine or blood ketones,
Ca, P, urea, Cr, glucose q30-60min, neuro vital signs
Cushing's triad indicates cerebral edema
- low HR, high BP, irregular RR
Tx: elevate bed, stop fluids, mannitol
Insulin regimen with 3 meals + 3 snacks