Emergency Department, ICU and Inpatient Clinical Pathway for
Evaluation/Treatment of Children with Suspected Diabetic Ketoacidosis (DKA)
60 min
ED Triage
POC glucose, POC beta-hydroxybutyrate (BOHB)
POC glucose, POC beta-hydroxybutyrate (BOHB)
Team Assessment
- History and Physical Exam
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Assess
- MS, VS, dehydration
Risk for Cerebral Edema
- MS, VS, dehydration
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IV Access
- 2 PIV
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Initial Labs
- VBG, BMP, Mg, Phos, HgbA1C
HCG, CBC as indicated
- VBG, BMP, Mg, Phos, HgbA1C
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IV Fluids
- 20 mL/kg NS over 1 hr
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Monitor
- VS q15min, I/O hourly, start DKA Care Map
-
DKA Confirmed
- Glucose > 200 mg/dL and
- BOHB > 3 mmol and
- pH < 7.3 or HCO3 < 15 mmol/L
Ongoing Treatment
-
Care Goals
- Frequent MS, VS, PE assessment
- Initial NS bolus over 1st hr
- Insulin to start after 1st NS bolus
- Decrease blood glucose (BG)
- 50-100 mg/dL/hr
- Adjust dextrose
- Based on hourly BG
- Adjust K+
- Based on q2hr BMP/mag/phos
- ECG for < 2.5 or K > 6
IVF Rehydration, Electrolytes, Glucose |
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Electrolyte Abnormalities in DKA Na HCO3 is not recommended |
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Insulin |
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Labs Monitoring |
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Physical Monitoring |
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Admission Considerations |
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Resolution of DKA
- MS, VS improved, tolerating sips
- HCO3 > 15 mmol/L or < 15, BOHB < 2mmol/L
- Anion gap < 10
Evidence
- Diabetic Ketoacidosis in Children
- ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State
CHOP Programs
Educational Media
Related Links