Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Suspected Diabetic Ketoacidosis (DKA)
Child with Suspected DKA
DKA: Definition & Treatment Goals
DKA: Definition & Treatment Goals
60 Minutes
Initial FLOC/RN Team Assessment
Assess
- 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, POC BOHB
- VBG, BMP, Ca, Mg, PO4, Hb A1C
- HCG, CBC as needed
IV Fluids
- NS, 20 mL/kg over 1 hour
Diagnosis DKA by PE, History, Labs
Ongoing Treatment
- Begin 1.5 times maintenance with NS until
2 bag system ready - Continue 1.5 with 2 bag system
- Initial results
- Order K replacement based on BMP results
- Perform ECG if K < 2.5
- Order regular insulin at 0.1 units/kg/hr as soon as possible
- Start insulin infusion 1 hour AFTER fluid resuscitation begins
- Stop insulin pump during DKA treatment
- Decrease glucose 50-100 mg/dL per hour
- Order 2 bag system, D0 and D10 with electrolytes
- Begin dextrose when the child’s glucose is < 300 mg/dL or decrease in POC glucose > 100 mg/dL per hour
- VS, neuro assess q 15 minutes until stable
Posted: June 2006
Revised: January 2023
Authors: V. Srinivasan, MD; K. Lord, MD; C. Jacobstein, MD; S. Gaines, RN; J. Lavelle, MD; A. Ackerman, MD;
M. Vajravelu, MD; T. Kaushal, MD; T. Flowers, RN
Revised: January 2023
Authors: V. Srinivasan, MD; K. Lord, MD; C. Jacobstein, MD; S. Gaines, RN; J. Lavelle, MD; A. Ackerman, MD;
M. Vajravelu, MD; T. Kaushal, MD; T. Flowers, RN
Evidence
- Diabetic Ketoacidosis in Children
- DKA Care Map
- Flow Chart: DKA Treatment and Transitioning to SQ Insulin
CHOP Programs
Educational Media
Related Links