Pediatric Diabetic Ketoacidosis v1

Floating boxes:
Initial resuscitation bolus NS 20 cc/kg x 1
Consider repeat boluses for shock or poor perfusion. (Discuss with attending)
Initial Labs: Istat, CBC, CMP, Mg, Phos Beta-OH, Acetone, UA, ICON, VBG
Consider Underlying Infectious Trigger
Assess mental status
Contact ENdocrine and PICU
  • Hyperglycemia > 200 | Acidosis: PH < 7.3, HCO3 < 15 | Ketosis: +ketones (urine of blood)
    • Manage Acidosis
      • Insulin drip 0.1 units/kg/hr (max 7 units/hr)
      • Q1 hour finger stick glucose
      • Goal to decrease glucose by no more than 100/hr
      • DO not start if k+ < 4.0 (Discuss with attending)
    • Monitor For Complications
      • Cerebral edema (1% of DKA)
      • Acute change in MS
      • Signs of herniation
      • If present
        • Mannitol or 3% NS
        • Head of bed to 30 degrees
        • Stat non-contrast head CT
        • inform PICU/Neurosurgery
    • Manage Hydration
      • If K+ < 5.5
        • 1/2 NS (or NS) + 20 KPhos
          • @1.5 maintennance rate
        • when BS < 300 D5 1/2 NS (or NS) +20 Kphos
          • @1.5 maintennance rate
          • Electrolytes Q2H-Q4H
          • Monitor for hypokalemia

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