Diabetic Ketoacidosis
1. Admit to: (consider PICU)
2. Diagnosis: Diabetic ketoacidosis.
3. Condition: .
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: consider ECG monitoring, Accuchecks
q1-2h until glucose level is <200 mg/dL, daily weights, strict
inputs and outputs. O2 at 2-4 L/min by NC if needed.
7. Diet: NPO
8. IV Fluids: 0.9% saline 10-20 mL/kg over 1h, then
repeat until blood pressure and pulse are normal.
Then give 0.45% saline, and replace 1/2 of calculated
deficit plus insensible loss over 8h, replace remaining
1/2 of deficit plus insensible losses over 16-24h. Keep
urine output >1.0 mL/kg/hour.
Add KCL when potassium is <6.0 mEq/dL
| Serum K+ | IV KCl (mEq/L) |
| <3 | 40-60 |
| 3-4 | 30 |
| 4-5 | 20 |
| 5-6 | 10 |
| >6 | 0 |
Rate: 0.25-1 mEq KCL/kg/hr, maximum 1 mEq/kg/h or
20 mEq/h.
9. Medications:
-Regular insulin (Humulin) 0.05-0.1 U/kg/hr (50 U in 500 mL NS) continuous IV infusion. Adjust to
decrease glucose by 50-100 mg/dL/hr.
-If glucose decreases at less than 50 mg/dL/hr,
increase insulin to 0.14-0.2 U/kg/hr. If glucose
decreases faster than 100 mg/dL/hr, continue
insulin at 0.05-0.1 U/kg/h and add D5W to IV fluids.
-When glucose approaches 250-300 mg/dL, add
D5W to IV. Change to subcutaneous insulin (lispro
or regular) when bicarbonate is >15, and patient is
tolerating PO food; do not discontinue insulin drip
until one hour after subcutaneous dose of insulin.
10.
Extras and X-rays: consider CXR, ECG. Consider Endocrine
and dietary consults.
11. Labs:
- Dextrostixs q1-2h until glucose <200 mg/dL, then q4-6h.
- BMP, phosphate, Mg q3-4h;
- consider serum acetone, ABG
- CBC. UA, urine culture and sensitivity.
- consider blood cultures +- starting Abx
Dehydration
-Admit to
-diagnosis:
-etc.
Newborn fever
RSV
Asthma exacerbation
cellulitis
ALTE
cellulitis
pneumonia
fever
RSV
diarrhea
jaundice
child abuse