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Pediatric DKA Management Guide

This document provides an overview algorithm for the management of diabetic ketoacidosis (DKA) in children and young people under 18. It outlines the clinical signs, history, biochemistry, and steps for confirming a diagnosis of DKA. For patients presenting with shock, the steps are resuscitation and intravenous fluid therapy. For non-shocked patients, a slow fluid bolus is given. The algorithm then provides guidance on monitoring, managing persisting acidosis or falling blood glucose, and resolution criteria.

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Abhinav Aggarwal
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643 views1 page

Pediatric DKA Management Guide

This document provides an overview algorithm for the management of diabetic ketoacidosis (DKA) in children and young people under 18. It outlines the clinical signs, history, biochemistry, and steps for confirming a diagnosis of DKA. For patients presenting with shock, the steps are resuscitation and intravenous fluid therapy. For non-shocked patients, a slow fluid bolus is given. The algorithm then provides guidance on monitoring, managing persisting acidosis or falling blood glucose, and resolution criteria.

Uploaded by

Abhinav Aggarwal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Overview Algorithm for the Management of

Children and Young People under the age of


18 years with Diabetic Ketoacidosis
Version 1 - 2022-01-24
Clinical Signs:
- Dehydration
- Kussmaul breathing
Clinical History: - Ketotic smell Biochemistry:
- Polyuria/polydipsia - Lethargy, drowsiness - Hyperglycaemia
- Weight loss (>11mmol/L)
- Abdominal pain - Acidaemia (pH<7.3)
- Weakness Confirm diagnosis - Ketosis (blood ketones
- Vomiting DIABETIC KETOACIDOSIS >3mmol/L or urine
- Confusion ketones ++)
Call senior staff
pH <7.1 = Severe DKA (10% dehydration
pH <7.2 = Moderate DKA (5% dehydration)
pH <7.3 = Mild DKA (5% dehydration

- Tachycardia
- Prolonged central capillary refill
- Poor peripheral pulses
- Hypotension (late sign)
Is the patient
Yes No
shocked?

Resuscitation Slow Bolus


Airway +/- NG tube - 10mL/kg fluid* bolus over 30 min
Breathing 100% O2 Intravenous therapy
Circulation
- Calculate fluid requirements: dka-calculator.co.uk
- 10mL/kg fluid*
- Use fluid* with 40 mmol/L potassium (check serum
- Repeat until circulation restored Signs of cerebral oedema:
K+ in normal range and urine output first) - Headache, irritability
- By 40mL/kg discuss with senior - Slowing HR
- Start insulin at 0.05 or 0.1 Units/kg/hour 1-2 hours
doctor and consider inotropes - Reduced GCS / coma
after starting fluids - Signs of raised ICP
- Others as show on care pathway

Acidosis Features of
failing to cerebral
improve? Observations oedema?
- Hourly blood glucose - 1-2 hourly blood
ketones
- Hourly neuro obs and fluid balance Management of Cerebral Oedema
Management of Persisting Acidosis
- Check electrolytes at 2 hours, then 4 hourly
- Give 5mL/kg 2.7% Sodium
- Re-evalutate fluid balance - may Chloride OR 20% Mannitol 2.5 - 5
require further resus fluid
mL/kg
- Check insulin rate and running Blood
properly - Call senior staff
glucose
- Consider sepsis and other <14mmol/L - Restrict IV fluids by 50%
differentials as per care pathway - Refer to care pathway for further
- Consider restarting protocol actions

- Change fluids* to contain 5% glucose


Blood glucose * 0.9% Sodium Chloride or Plasmalyte 148
<6mmol/L - Continue monitoring as above

Management of Falling Blood Resolution of DKA


Glucose - Clinically well, tolerating oral fluids, blood ketones <1mmol/L or pH normal
- Change fluids* to contain 10% - Start S/C insulin THEN stop IV insulin 1 hour later
glucose
- Do not reduce insulin below 0.05
Units/kg/hour if ketones >1
mmol/L This algorithm is a summary of the main care pathway and should not be considered as a complete guide
- If glucose falls below 4mmol/L to the management of paediatric DKA.
refer to care pathway for
management of hypoglycaemia Refer to the main care pathway at the earliest opportunity by visiting dka-calculator.co.uk or the BSPED
guidelines page.

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