Management of Diabetic Ketoacidosis in the Children’s ED
Triage Level 2 if Suspicion for DKA
Notify Attending Physician
Place on a Monitor
Maintain/Initiate
NPO status
Obtain Peripheral IV Access
Perform bedside POCT:
iStat 8, dextrose and iStat4
Order/Send Diabetes Labs
Using the DKA Order Set
While waiting for confirmatory labs give a 10
ml/kg bolus of normal saline
If poor perfusion increase
bolus to 20 ml/kg
Consult Pediatric Endocrine/Diabetes
If pH less < or= 7.2 notify the
Pediatric Intensive Care Unit
Initiate fluid management (see next page) and order Insulin 0.1
U/kg/hr (be sure to flush the line before starting the infusion, NO
bolus of Insulin)
At this time (Approx 1 hr LOS) obtain a second iStat 8
and iStat 4. Place a second peripheral IV. If unable, place
a bifuse on primary PIV Hub.
If the patient has the following criteria:


pH is <7.2
Patient is age 3 or less

Patient is exhibiting an alteration in mental status
or has a complicating factor (secondary illness)
confirm admission to the PICU and notify the
attending
If the glucose is <250 mg/dl start an infusion of
dextrose and do not delay the initiation of insulin
If patient is in stable DKA and does
not exhibit the criteria to the leftAdmit to 7-2 MC
nfusion of dextrose
but don’t delay the initiation of insulin. Initiate 2 bag
system with initiation of Insulin infusion. Utilize 2
separate Sigma pumps (1 for Insulin) (1 for IVF)
Fluid Management for Diabetic Ketoacidosis
Rate (ml/hr)= Maintenance plus ½ deficit (assuming 10% deficit) over 24 hrs
Ideally NS with 20 mEq/L of KCL and 20 mEq/L of KPhos
(In the Children’s ED, you may use NS with 40 mEq/L of KCl)
and
If dextrose < 250 mg/dl use D10NS with 20 mEq/L of KCL and 20 mEq/L of KPhos
(In the Children’s ED, you may use D10NS or D10)