DIABETIC KETOACIDOSIS MANAGEMENT HIGHLIGHTS

Fluid resuscitation

Start 0.9% NaCl at 15–20 mL/kg/hr for first hr (add colloid if

hypovolemic shock), then

If Na+ is normal or high, give 0.45% NaCl at 4–14 mL/kg/hr

If Na+ is low, give 0.9% NaCl at 4–14 mL/kg/hr

Add dextrose when glucose is < 250 mg/dL

Goal is to correct total body water deficit in the first 24 hr

Insulin therapy

0.1 U/kg bolus followed by continuous infusion at 0.1 U/kg/hr

Goal is to decrease glucose by 50–75 mg/dL/hr

Continue insulin until pH, bicarbonate, and anion gap normalize

Overlap IV insulin with subcutaneous insulin for 1–2 hr after resolution

of DKA

Electrolyte repletion

Add 20–30 mEq potassium to each liter of IV fluid if potassium is

< 5.3 mEq/L

Replace phosphate if phosphate is < 1 mg/dL

Give bicarbonate if pH is < 7.0