Pediatric Monitoring and
Assessment in DKA

Patient Monitoring - Consider Early Pediatric Referral

  • Glucometer/Blood Glucose hourly initially
     
  • Osmolality, BUN, Creatine, Ns, K, Cl, Glucose hourly until stable
     
  • Cap gas hourly initially, then every 2-4 hours until normal or near normal
     
  • Baseline CBC, Urine analysis
     
  • Intake and output hourly
     
  • Urine Ketones hourly initially
     
  • Level of Consciousness and Neurovital signs hourly until stable
     
  • Weigh every 12 hours
     
  • Search for precipitating cause of DKA (i.e. infection, non-adherence to insulin)
     
  • Suspect Cerebral Edema if Bradykardia, decreasing level of Consciousness, Headache, or Seizure. Treat with intubation, Hyperventiliation and Mannitol 0.5/Kg IV

 

Fluid Replacement (over first 24 hours)

1 - Deficit (ml/Kg Body Weight for degree of hydration)

AGE MILD MODERATE SEVERE
>2 yrs 30 60 90
<2 yrs 50 100 150

2 - Maintenance Fluid

  • 4cc/Kg/hr for first 10 Kg
  • 2cc/Kg/hr for next 10Kg
  • 1cc/Kg/hr for each Kg above 20 Kg

 

Calculations

  • Corrected Serum Na = Na + [(glucose - 5.6) X 0.3]
     
  • Osmolality = 2Na + BUN = glucose

 

SC Insulin Schedules (Start when patient drinking/eating well)

Resume former insulin schedule
OR
Mix intermediate and short-acting insulin together
  1. 0.6U/Kg/24hr
  2. Give 2/3 the total dose before breakfast and 1/3 the total dose before supper in a 2/3 - 1/3 split for each
OR
Discuss with Pediatrician

 

- Maureen Allen

Thanks to Dr. Leo Pereira, Deptartment of Internal Medicine, St. Martha's Regional Hospital in Antigonish Nova Scotia for reviewing the draft copy of this article.

You can search for abstracts of the above references by following this link: PubMed

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