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Diabetic ketoacidosis treatment protocol with fluid and insulin management
DKA is life-threatening. This calculator is for TRAINED MEDICAL PROFESSIONALS only. Requires ICU-level monitoring. Pediatric DKA has cerebral edema risk. Follow institutional protocols. Frequent labs and neuro checks required.
| Severity | pH | HCO3 (mEq/L) | Anion Gap | Mental Status |
|---|---|---|---|---|
| Mild | 7.25-7.30 | 15-18 | >10 | Alert |
| Moderate | 7.00-7.24 | 10-15 | >12 | Alert/drowsy |
| Severe | <7.00 | <10 | >12 | Stupor/coma |
Also requires: Glucose >250 mg/dL and positive ketones (blood or urine)
Most serious complication in children (0.5-1% incidence). Mortality 20-40%.
Signs:
Treatment:
Total body K+ depleted despite normal/high serum levels. Droplets with insulin treatment.
Management:
From excessive insulin or inadequate dextrose when glucose drops.
Prevention:
Gap not closing despite treatment. Consider alternative diagnoses.
Differential:
Anion gap <12, pH >7.3, HCO3 >18. Patient must be tolerating PO intake. Transition to subQ insulin with 1-2 hour overlap to prevent recurrence.
Insulin shuts off ketone production. Stopping insulin prematurely can cause ketoacidosis to persist despite normal glucose. Add dextrose to fluids and continue insulin until gap closes.
Rarely indicated. Consider only if pH <6.9 causing hemodynamic instability. Give 100 mEq in 400 mL water over 2 hours. May worsen hypokalemia and paradoxical CNS acidosis.
Aggressive fluid resuscitation takes priority. May give 20 mL/kg boluses (up to 30 mL/kg in adults) until perfusion improves. Severe dehydration can be 10% of body weight.
Children have higher cerebral edema risk. Avoid insulin bolus, limit initial fluids (<20 mL/kg), replace deficit slowly over 48 hours, and closely monitor neurological status.
DKA with glucose <250 mg/dL. Seen with SGLT2 inhibitors, pregnancy, reduced carb intake. Diagnosis requires high ketones and anion gap acidosis despite lower glucose.