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DKA MSF Poster

The document outlines the management protocol for acute diabetic ketoacidosis in children, requiring hyperglycemia and ketones presence, along with signs of severe metabolic acidosis or dehydration. It details fluid administration, insulin dosing, and monitoring of blood sugar levels, including specific actions based on blood sugar readings. Additionally, it emphasizes the need for careful reintroduction of oral alimentation and hydration after stabilization.

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dmasood.gulli.1995
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166 views1 page

DKA MSF Poster

The document outlines the management protocol for acute diabetic ketoacidosis in children, requiring hyperglycemia and ketones presence, along with signs of severe metabolic acidosis or dehydration. It details fluid administration, insulin dosing, and monitoring of blood sugar levels, including specific actions based on blood sugar readings. Additionally, it emphasizes the need for careful reintroduction of oral alimentation and hydration after stabilization.

Uploaded by

dmasood.gulli.1995
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MANAGEMENT ACUTE DIABETIC KETOACIDOSIS (CHILDREN) – OCG PED Team – October 2017

The next two criteria should be present: - Hyperglycaemia (blood glucose ≥ 11mmol or 200 mg/dl) • ABC, IV line / IO
- Ketones ++ or more on urine dipstick • Monitor BP, RR, PR, CRT,
Plus one or more of the following: clinical signs of severe metabolic acidosis (“Kussmaul” breathing), altered level of urine output and
consciousness, signs of severe dehydration, shock consciousness, hourly
during 1st hours, then
Check Hb: if > 6 g/dL follow algorithm below. If < 6 g/dL follow “Protocol for Transfusion during DKA” (part V in text) space depending on
evolution.
• Look for precipitating
Bolus: 10ml/kg Ringer Lactate (or NaCL 0.9%) in 60 min factors ( e.g.
(if shock, bolus can be given more rapidly and repeated until signs of shock resolve (max 3 times) infection, lack of insulin)

FLUIDS Short acting Insulin (actrapid) IM K

Ringer lactate at 1.5 x daily requirements 0.1 UI/kg every 2 hours Add K to maintenance fluids after
(4-2-1 rule) 1hr after beginning of IV fluids the first hour of treatment if the
Continue IVF for minimum 24 hours patient is passing urine

40 mmol KCl in 1000 ml of


RANDOM BLOOD SUGAR (RBS) every 1 hour:
maintenance fluids
When RBS < 15 mmol/L (300 mg/dl), OR a fall in Change to dextrose 5%-RL and continue insulin to maintain
→ KCl 10%, amp 10 ml:
glycaemia of >5mmol/L/hr (90mg/dl) glucose levels at 8-11 mmol/L (150 -200 mg/dl )
13.4mmol/vial
If RBS < 5 mmol/L (90mg/dl) or continues Change to D10%-RL and continue insulin to maintain glucose Add 3 vials to 1 litre
→ Or 1,5 vials to 500ml
decreasing >5mmol/L/hr despite D5%- RL levels at 8-11 mmol/L (150 -200 mg/dl )

Give a bolus of 2 ml/kg of 10%, HOLD insulin, continue D10%-


If RBS < 4 mmol/l (70mg/dl) → RL and check RBS in 30 min.
Thiamine IV in children who have
Restart insulin as soon as RBS ≥ 5 mmol/L
persistent acidosis, increasing insulin
requirements & persistent
NOTE: → Consider to decrease the insulin dose if repeatedly low RBS despite D10%-RL encephalopathy in spite of appropriate
→ Consider to increase insulin dose if RBS does not decrease over 6-8 hrs therapy:
Slow IV infusion (over 30 min):
After stabilization + no signs of acidosis + patient fully awake - < 13 years old → 100 mg / 12h for
Carefully introduce oral alimentation and hydration + start NPH first 48 hours
- > 13 years & adults → 200 mg / 12h
For new patients: NPH dose to start: 0.5-0.8 U/kg/day (2 / 3 morning – 1 / 3 evening)
for first 48 hours
For known diabetic on insulin: restart home dose * Refer to Diabetes type 1 management protocol

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