ED Pathway for the Evaluation/Treatment of the Child With Suspected DKA
Child with Suspected DKA
DKA: Definition & Treatment Goals
60 Minutes
Initial MD/CRNP/RN Assessment
  • ABC, VS, level of dehydration
  • Mental status, neuro exam, GCS
  • Risk for cerebral edema
  • CR monitor, VS q 15 min, I/O q 1 hr
  • Start DKA Flow Sheet
IV Access
  • 2 PIV (fluid resuscitation, blood draws)
Initial Labs
  • POC glucose, blood or urine for ketones
  • VBG, BMP, Ca, Mg, PO4, CBC, Hb A1C
  • HCG, CBC as needed
IV Fluids
  • NS, 10 mL/kg
Diagnosis DKA by PE, History, Labs
Ongoing Treatment
  • Assess need for 2nd 10 mL/kg bolus
  • Begin 1.5 - 2 times maintenance w/NS until 2 bag system ready
  • Initial results
  • Order K replacement based on BMP results
  • Order regular insulin at 0.1 units/kg/hr as soon as possible
  • Start insulin infusion 1 hour AFTER fluid resuscitation begins
  • Decrease glucose 50-100 mg/dL per hour
  • Order 2 bag system, D0 and D10 with electrolytes
  • Add glucose when blood sugar is < 300 mg/dL
  • VS, neuro assess q 15 minutes until stable
  • Use DKA Flow Sheet, refer to RN DKA Caremap
Posted: June 2006
Revised: August 2011, November 2014, November 2015
AuthorsA. Palladino, MD; V. Srinivasan, MD; K. Lord, MD; C. Jacobstein, MD; S. Gaines, RN; J. Lavelle, MD;
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