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Dka Calculator

1) The document provides guidelines for diagnosing and treating paediatric diabetic ketoacidosis (DKA). DKA is diagnosed if blood glucose is above 11mmol/L, pH is below 7.3, and bicarbonate is below 15 mEq/L with ketones above 3 mmol/L. 2) Treatment involves slow rehydration and metabolic correction over 48 hours to reduce the risk of cerebral edema. Fluid therapy is based on weight and degree of dehydration. Monitoring includes hourly vital signs, blood glucose, and ketones. 3) Insulin therapy should begin after 1 hour of rehydration fluid at a rate of 0.1 units/kg/hour. H

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202 views1 page

Dka Calculator

1) The document provides guidelines for diagnosing and treating paediatric diabetic ketoacidosis (DKA). DKA is diagnosed if blood glucose is above 11mmol/L, pH is below 7.3, and bicarbonate is below 15 mEq/L with ketones above 3 mmol/L. 2) Treatment involves slow rehydration and metabolic correction over 48 hours to reduce the risk of cerebral edema. Fluid therapy is based on weight and degree of dehydration. Monitoring includes hourly vital signs, blood glucose, and ketones. 3) Insulin therapy should begin after 1 hour of rehydration fluid at a rate of 0.1 units/kg/hour. H

Uploaded by

Talib Adil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Paediatric Diabetic Ketoacidosis

Diagnosis of DKA = blood glucose >11mmol/L


and pH<7.3 bicarb <15 mEq/L
Finger prick blood ketone > 3 mmol/L
Use guideline if >5% dehydrated, vomiting,
drowsy or clinically acidotic
MAJOR RISK = CEREBRAL OEDEMA
Aim for slow metabolic correction over 48 hrs

FLUID THERAPY
Fluid Maintenance

0 - 12.9 kg
13 -19.9 kg
20 -34.9 kg
35 -59.9 kg
> 60 kg

80
65
55
45
35

ml/kg/24
ml/kg/24
ml/kg/24
ml/kg/24
ml/kg/24

hrs
hrs
hrs
hrs
hrs

Neonates may need 100ml/kg/day

British Society for Paediatric


Endocrinology and Diabetes

DATE

Emergency Management

MONITORNG:

1) Airway: if coma, insert airway. NGT if coma of


vomiting
2) Breathing:give 100% oxygen by face mask
3) Circulation: Insert IV cannula, take blood smaples
4) If shocked, 10ml/kg 0.9% saline bolus, up to 30ml/kg
5) Confirm diagnosis of DKA
6) Investigations: blood glucose, plasma Na, Cl, Ur, Cr

1)
2)
3)
4)
5)
6)
7)

Calculate

Weight

PATIENT NAME

Print

Enter patient weight (kg)


Degree dehydration (%)

Total resus volume (ml)

Strict fluid balance (input / output)


Hourly BP and vital signs
Hourly blood glucose
Blood ketones (1-2 hrly if available)
Acid base, plasma Na, K, Cl (4 hrly)
12 hrly weight
HDU /PICU if coma, pH<7.1, <1 yr

Maintenance rate (ml/kg/day)

TOTAL ML PER DAY *

Maintenance volume over 48hrs (ml)

TOTAL (ML/KG/DAY)

Rehydration volume over 48hrs (ml)

TOTAL (ML/HOUR)

Total fluid /48hrs (ml) minus ressus fluid

TOTAL (ML/KG/HR)

Use 0.9% saline for 1st 12 hrs


*includes subtracting ressus fluid given from total fluid requirement over 48 hrs

INSULIN (Only start infusion after 1st hr of resus fluid)

Corrected Na (failure to increase = risk cerebral oedema)

Add 50 units insulin to 50ml solution of 0.9% saline


(concentration 1 unit/ml, 0.1u/kg/hr = 0.1ml/kg/hr)

Sample1

Glucose (mmol/L)
Required insulin infusion rate (units/kg/hr) 0.1

Plasma Na (mmol/L)
Corrected Na

DO NOT REDUCE insulin rate until ketoacidosis improves


If glucose falls (<14 mmol/L) add Glucose to IVI fluids.
Simplified Corrected Na formula
= plasma Na (0.3x (Glu - 5.5)

GLUCOSE
CALCULATOR

Size Infusion bag(ml)

% Glucose at Start 5

Sample2

Corrected Na should rise with


therapy (0.5-1mmol/hr)
If associated with falling GCS:
consider osmotherapy
1) 5ml/kg of 2.7% saline or
2) 0.5-1 gramm/kg mannitol
3) Consider CT head
4) 2.7% saline can be repeated
(even if Na is high)
See www.strs.nhs.uk for information

% Glucose needed
http://www.bsped.uk

Reference: ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child. 2004 Feb;89
(2):188-94

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