Pediatric DKA Protocol
1.
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6.
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8.
9.
Admit to PICU.
Diagnosis DKA.
Hourly vital signs. Place on cardiac monitor and continuous pulse oximetry.
GCS every 1 hour.
Weight on admission, then daily at 2100.
Elevate HOB 30⁰-45⁰.
NPO except ice chips.
Intake and output hourly.
Bedside glucose hourly. Call for blood glucose changes over 200 mg/dL in 1 hour or if blood
glucose less than 80 mg/dL.
10. BMP now and every 4 hours. Venous pH and pCOs every 2 hours twice and once in AM.
Amylase/lipase now.
11. IV Fluids: Bolus 0.9% NS ____ ml over 1 hour (20 ml/kg)
Maintain fluids (1.5 x maintenance) IV fluid rate ______ ml/hr
If serum potassium greater than or equal to 5.5, verify IV fluid order with provider.
Bag 1
Bag 2
Blood
glucose
mg/dL
 350
301-350
251-300
201-250
 200
 100
20 mEq/L potassium phosphate and 20 mEq/L
potassium acetate in 0.9% NS
20 mEq/L potassium phosphate and 20 mEq/L
potassium acetate in D10 0.9% NS
100% of predetermined rate of IV fluids
75% of predetermined rate of IV fluids
_________mL/hr
50% of predetermined rate of IV fluids
_________mL/hr
25% of predetermined rate of IV fluids
_________mL/hr
Zero of predetermined rate of IV fluids
Zero of predetermined rate of IV fluids
Zero of predetermined rate of IV fluids
25% of predetermined rate of IV fluids
_________mL/hr
50% of predetermined rate of IV fluids
_________mL/hr
75% of predetermined rate of IV fluids
_________mL/hr
100% of predetermined rate of IV fluids.
100% of predetermined rate of IV fluids.
Hold insulin and notify provider.
12. Continuous insulin drip: 0.1 unit/kg/hr (1 unit/1ml).