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 |