- Obtain two IV sites; one for IV fluids and Insulin drip and the other for lab draws.
- Bolus with 0.9% normal saline 10-20 ml/kg (if indicated).
- Obtain rapid bedside blood glucose, electrolytes and ABG via I-Stat analysis every hour.
- Begin Insulin drip
- Mix 100 units regular insulin in 100 ml of NS to make a solution of 1unit/ml.
- Clear tubing with 50 ml of solution to saturate tubing binding sites.
- Begin insulin drip at 0.1units/kg/hr. Lower dose (0.05 unit/kg/hr) used in younger children to avoid rapid drop in glucose.
- Desired rate of decline in serum glucose is 80-100 mg/dl per hour. Check glucocheck hourly.
- Add dextrose to IVF when serum glucose levels fall to 250-300.
- After fluid resuscitation, start maintenance fluids
- NS at 1.5X maintenance rate
- Add 20 mEq/L KCl to each liter of IV fluid when K+ < 5.5 mEq/L if possible
- Observe for cerebral edema.
- Consider mannitol (Osmitrol): 0.5-1 g/kg IV over 30 minutes for patients with changes in level of consciousness, confusion, pupil inequality, posturing or seizures, measure glucose and correct if hypoglycemic.
- Intubate for neurologic deterioration and signs & symptoms of herniation. (See: Rapid Sequence Induction and Intubation)
- DO NOT treat with sodium bicarbonate.
- DO NOT treat with IV insulin bolus.
- BSPED recommended guidelines on diabetic ketoacidosis 2004 (http://www.bsped.org.uk/professional/guidelines/docs/BSPEDDKAApr04.pdf)
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