Inpatient Clinical Pathway for Evaluation/Treatment of Children with Diabetic Ketosis without Acidosis
- Endocrine Consult
- Obtain for patients with DM receiving insulin if not on the Endocrine service
- Fluid and Insulin Management
- Fluid Management
- Insulin Pump Management
- Insulin Dosing
- Basal Insulin/Routine Regimen
- Correction Factor
- Correction Bolus
- Ketone Dose
- Diabetes Care Flow Chart
- Initial Assessment
- Check POC glucose
- Check POC Ketones by:
- Blood β-hydroxybutyrate (BOHB) or
- Urine Ketones
- Do not Hold Basal Insulin
- Review History and Physical Exam
Ketones | Blood Glucose | Treatment | Reassessment |
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BOHB 1-3 Urine ketones moderate 40-79 |
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> 3 Urine ketones: large (> 80) |
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- BOHB < 1 or Urine ketones < Small
- End Pathway Treatment
- Start Regular Day Diabetes Management
- If patient is requesting to eat, check BG and dose insulin for carbohydrate intake and glucose correction. Otherwise resume pre-feed glucose checks
Calculating the Insulin Dose Administer ketone dose or correction bolus, whichever is greater, but not both. |
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Calculation | Description | Equation |
Ketone Dose |
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Correction Bolus |
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Correction Factor |
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Posted: October 2017
Last Revised: October 2024
Authors: K. Lord, MD; S. Dumser, RN, CNS; M. Killberg, MD; J. Phillips, RN
Last Revised: October 2024
Authors: K. Lord, MD; S. Dumser, RN, CNS; M. Killberg, MD; J. Phillips, RN