How is pediatric DKA treated?
Management of DKA should occur in centers with treatment experience and monitoring capability. Fluid replacement begins with 0.9% saline to restore circulation and subsequent 0.45% saline for maintenance and replacement of 5%–10% dehydration, according to severity indicators.
What is the DKA protocol?
A mix of 24 units of regular insulin in 60 mL of isotonic sodium chloride solution usually is infused at a rate of 15 mL/h (6 U/h) until the blood glucose level drops to less than 180 mg/dL; the rate of infusion then decreases to 5-7.5 mL/h (2-3 U/h) until the ketoacidotic state abates.
How do you lower ketones in children?
Ketone Treatment Guidelines
- Step 1: Provide Insulin Dosing. If ketones are negative, trace, or small, continue normal insulin dosing.
- Step 2: Drink Fluids. Drinking fluids is an important step to reducing your child’s ketone levels.
- Step 3: Recheck Your Child’s Blood Sugar.
Why is there no insulin bolus pediatric DKA?
The second important difference is the administration of insulin. While insulin is bloused in the adult patient, insulin boluses are contraindicated in the pediatric patient with DKA. Monitoring and correction of potassium is heavily stressed in the adult patient with DKA.
What IV fluids are given for DKA?
Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.
When do you give Bicarb to DKA?
Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9.
What IV do you give for DKA?
How much fluid do you give in DKA?
Most protocols call for an initial bolus of isotonic crystalloid solution (0.9% saline) at a starting rate of 15–20 mL/kg/h (1–1.5 L/h) for the first hour. Following the initial hydration, fluids can be administered at a decreased rate of 4–14 mL/kg/h.
Why do you give potassium in DKA?
Treatment with insulin will cause a shift of potassium intracellularly which can lead to severe hypokalemia and cardiac dysrhythmia. All DKA patients will require potassium replacement to prevent hypokalemia. Generally 20mEq of potassium in each liter of fluid given will maintain a normal serum potassium concentration.
What happens If DKA is not treated?
One of the ketone bodies formed (acetone) leaves the body via the lungs, giving the breath of the person with DKA a characteristic, fruity smell. This is how DKA can be detected. DKA can induce coma or even death if not treated immediately. Signs & symptoms of DKA:
What causes dka in children?
Not enough insulin
How to manage DKA?
Management. Children and adolescents with DKA should be managed in a unit that has: Access to laboratory services for frequent and timely evaluation of biochemical variables; Experienced nursing staff trained in monitoring and management of DKA in children and adolescents
How is DKA treated?
Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment. Possible complications of the treatments.