Pedemy All toolsAnswer one question at a time. The plan gives fluid, insulin and potassium steps with weight-based doses. Tap any earlier answer to change it.
This pathway guides clinicians through managing pediatric diabetic ketoacidosis, with weight-based fluid, insulin and potassium steps. It also covers hyperglycemic hyperosmolar state and cerebral injury.
DKA is defined as glucose over 200 mg/dL (11 mmol/L), venous pH under 7.3 or bicarbonate under 18, and BOHB 3 mmol/L or more. Signs of cerebral injury are checked first, using diagnostic, major and minor criteria; if they are met, mannitol or 3% hypertonic saline is given without waiting for imaging. Severity is graded by pH or bicarbonate (mild, moderate, severe) and sets the assumed deficit at 5%, 7% or 10%. Circulation decides the bolus, 10 to 20 mL/kg of 0.9% saline, and the remaining deficit plus maintenance is replaced over 24 to 48 hours. Potassium under 3.0 mmol/L means holding insulin and replacing potassium first.
The plan gives a regular insulin infusion of 0.05 to 0.1 units/kg/h, started at least 1 hour after fluids and without a bolus, or subcutaneous rapid-acting insulin for uncomplicated cases. It adds dextrose at 250 to 300 mg/dL and lists resolution criteria. It follows the ISPAD Clinical Practice Consensus Guidelines 2022.
Regular insulin is given IV at 0.05–0.1 units/kg/h, started at least 1 hour after fluids begin, with no bolus. A rate of 0.05 can be considered if pH is over 7.15. Insulin is held until potassium is 3.0 mmol/L or higher.
Add 5% dextrose when glucose reaches 250–300 mg/dL (14–17 mmol/L), or sooner if it falls faster than 90 mg/dL per hour. Use 10% or 12.5% dextrose if needed, and never stop insulin while the child is still acidotic.
Give mannitol 20% at 0.5–1 g/kg IV over 10–15 minutes, or 3% hypertonic saline at 2.5–5 mL/kg, as soon as cerebral injury is suspected; do not wait for imaging. Elevate the head of the bed, avoid hyperventilation and admit to the PICU.
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