Diabetic Ketoacidosis (DKA) — Considerations for ICU Admission — Clinical Pathway: Emergency Department, ICU and Inpatient

Diabetic Ketoacidosis (DKA) Clinical Pathway — Emergency Department, ICU and Inpatient

ICU Admission Indications and Considerations

  • The majority of children with DKA can be managed safely on the medical unit
  • ICU care is needed for children at risk for clinically significant cerebral edema
  • ICU admission is indicated for children with concern for Hyperosmolar Hyperglycemic State (HHS)
  • Risk remains for 24-48 hrs after treatment is initiated, even if laboratory measures are improving
  • Location of admission is determined with ED, Endocrine and PICU discussion
  • EMCP will review with Endocrine, PICU as needed for transferred children
ICU Admission is Indicated
  • Age < 2 yrs
  • Altered mental status:
    • GCS ≤ 13
    • Cranial nerve deficits
    • VS changes c/w Cushing’s Triad
    • CT with cerebral edema
    • Other concerns for cerebral edema, intracranial pathology
    • Cerebral Edema
  • Persistent pH < 7
  • Shock state, poor perfusion
  • Co-ingestion
ICU Admission is Considered
  • Age 2-5 yrs
  • pH > 7.0 with HCO3 on BMP < 5
  • Nacorrected > 160 mEq/L at any time during treatment
  • K < 3.5 mEq/L with EKG changes