Diabetic ketoacidosis (peds) - Revision history

Danbot: Add MedicationDose templates for insulin and sodium bicarbonate in pediatric DKA

2026-03-20T22:23:33Z

Add MedicationDose templates for insulin and sodium bicarbonate in pediatric DKA

← Older revision		Revision as of 22:23, 20 March 2026
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	===Manage [[Acidosis]]<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>===		===Manage [[Acidosis]]<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>===
	*[[Insulin]] drip 0.1 units/kg/hr		*{{MedicationDose\|drug=Insulin\|dose=0.1 units/kg/hr IV drip\|route=IV drip\|context=DKA management\|indication=Diabetic ketoacidosis (peds)\|population=Pediatric\|notes=Do not start if K+ <4.0; decrease to 0.05 units/kg/hr when transitioning to SC}}
	**Do not start if K+ <4.0 (replete K+ first)		**Do not start if K+ <4.0 (replete K+ first)
	**Continue until HCO3 >15 and pH >7.3, then transition to SC insulin		**Continue until HCO3 >15 and pH >7.3, then transition to SC insulin
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	**Critically ill (hemodynamic compromise from decreased contractility) AND		**Critically ill (hemodynamic compromise from decreased contractility) AND
	**pH <7.0		**pH <7.0
	*0.5-2 mEq/kg over 1-~~2hr~~		*{{MedicationDose\|drug=Sodium bicarbonate\|dose=0.5-2 mEq/kg over 1-2 hr\|route=IV\|context=Only if pH <7.0 and hemodynamic compromise\|indication=Diabetic ketoacidosis (peds)\|population=Pediatric\|notes=Correction should never exceed pH >7.1 or bicarb >10}}
	**Correction should never exceed pH > 7.1 or bicarb >10		**Correction should never exceed pH > 7.1 or bicarb >10

Ostermayer at 21:01, 15 January 2026

2026-01-15T21:01:52Z

← Older revision		Revision as of 21:01, 15 January 2026
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	{{~~Peds top~~}} ~~[[diabetic ketoacidosis]]~~		{{PediatricPage\|diabetic ketoacidosis}}
	==Background==		==Background==
	*DKA + altered mental status = [[Cerebral edema in DKA\|cerebral edema]] until proven otherwise		*DKA + altered mental status = [[Cerebral edema in DKA\|cerebral edema]] until proven otherwise

Rossdonaldson1: /* Background */

2025-04-16T21:51:08Z

Background

← Older revision		Revision as of 21:51, 16 April 2025
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	{{Peds top}} [[diabetic ketoacidosis]]		{{Peds top}} [[diabetic ketoacidosis]]
	==Background==		==Background==
	*DKA + altered mental status = cerebral edema until proven otherwise		*DKA + altered mental status = [[Cerebral edema in DKA\|cerebral edema]] until proven otherwise

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Potassium */

2025-04-16T21:50:01Z

Potassium

← Older revision		Revision as of 21:50, 16 April 2025
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	===Potassium===		===Potassium===
	*if <2.5, hold insulin and give 1 meq/kg potassium KCL in IV over 1hr		*if <2.5, hold insulin and give 1 meq/kg potassium KCL in IV over 1hr
	**No insulin until K > 2.5		**No insulin until K >2.5
	*if >2.5 but <3.5 give 40-60 meq/L in IV until K >3.5		*if >2.5 but <3.5 give 40-60 meq/L in IV until K >3.5
	*if >3.5 but <5.5 give 30-40 meq/L in IV for K = 3.5 - 5		*if >3.5 but <5.5 give 30-40 meq/L in IV for K = 3.5 - 5

Rossdonaldson1: /* Potassium */

2025-04-16T21:49:47Z

Potassium

← Older revision		Revision as of 21:49, 16 April 2025
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	===Potassium===		===Potassium===
	*if < 2.5, hold insulin and give 1 meq/kg potassium KCL in IV over 1hr		*if <2.5, hold insulin and give 1 meq/kg potassium KCL in IV over 1hr
	**No insulin until K > 2.5		**No insulin until K > 2.5
	*if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5		*if >2.5 but <3.5 give 40-60 meq/L in IV until K >3.5
	*if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5		*if >3.5 but <5.5 give 30-40 meq/L in IV for K = 3.5 - 5
	*if > 5.5, then check K q1hr		*if >5.5, then check K q1hr

	===[[Bicarbonate]]<ref>[[EBQ:Sodium Bicarbonate use in DKA]]</ref>===		===[[Bicarbonate]]<ref>[[EBQ:Sodium Bicarbonate use in DKA]]</ref>===

Rossdonaldson1: /* Potassium */

2025-04-16T21:49:10Z

Potassium

← Older revision		Revision as of 21:49, 16 April 2025
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	===Potassium===		===Potassium===
	*if < 2.5, hold insulin and give 1 meq/kg [[potassium]] KCL in IV over 1hr		*if < 2.5, hold insulin and give 1 meq/kg potassium KCL in IV over 1hr
	**No insulin until K > 2.5		**No insulin until K > 2.5
	*if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5		*if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5

Rossdonaldson1: /* Potassium */

2025-04-16T21:48:28Z

Potassium

← Older revision		Revision as of 21:48, 16 April 2025
Line 55:		Line 55:

	===Potassium===		===Potassium===
	*if < 2.5, hold insulin and give 1 meq/kg [[potassium KCL in IV over 1hr		*if < 2.5, hold insulin and give 1 meq/kg [[potassium]] KCL in IV over 1hr
	**No insulin until K > 2.5		**No insulin until K > 2.5
	*if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5		*if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5

Rossdonaldson1: /* Manage HydrationCooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5 */

2025-04-16T21:47:52Z

Manage HydrationCooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5

← Older revision		Revision as of 21:47, 16 April 2025
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	**0.45% NS (or NS) + 20 KPhosat 1.5 x [[IVF maintenance\|maintenance rate]]		**0.45% NS (or NS) + 20 KPhosat 1.5 x [[IVF maintenance\|maintenance rate]]
	***When BS <300, change to D5/0.45%NS (or NS) +20 KPhos at 1.5 x [[IVF maintenance\|maintenance rate]] (maintain BS 150-250)		***When BS <300, change to D5/0.45%NS (or NS) +20 KPhos at 1.5 x [[IVF maintenance\|maintenance rate]] (maintain BS 150-250)
	*In a retrospective study, lactated ringers when compared with normal saline was associated with lower total cost and rate of development of cerebral edema. <ref>Bergmann, K. R., Jennifer Abuzzahab, M., Nowak, J., Arms, J., Cutler, G., Christensen, E., … Kharbanda, A. (2018). Resuscitation With Ringerʼs Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis. Pediatric Emergency Care, 1.</ref>		*In a retrospective study, lactated ringers when compared with normal saline was associated with lower total cost and rate of development of cerebral edema.<ref>Bergmann, K. R., Jennifer Abuzzahab, M., Nowak, J., Arms, J., Cutler, G., Christensen, E., … Kharbanda, A. (2018). Resuscitation With Ringerʼs Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis. Pediatric Emergency Care, 1.</ref>

	===Manage [[Acidosis]]<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>===		===Manage [[Acidosis]]<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>===

Rossdonaldson1: /* Clinical Features */

2024-02-01T00:37:21Z

Clinical Features

← Older revision		Revision as of 00:37, 1 February 2024
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	==Clinical Features==		==Clinical Features==
			[[File:PMC3937174 2251-6581-12-47-1.png\|thumb\|Frequency of signs and symptoms among 37 pediatric patients with diabetic ketoacidosis in Nigeria.]]
	*May be the initial presenting of an unrecognized Type-1 diabetes mellitus patient		*May be the initial presenting of an unrecognized Type-1 diabetes mellitus patient
	*Signs/symptoms may include:		*Signs/symptoms may include:

Sarahjabre: /* Clinical Features */

2023-12-19T12:18:22Z

Clinical Features

← Older revision		Revision as of 12:18, 19 December 2023
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	**[[Abdominal pain]], [[nausea and vomiting (peds)\|nausea/vomiting]]		**[[Abdominal pain]], [[nausea and vomiting (peds)\|nausea/vomiting]]
	**[[Altered mental status (peds)\|Altered mental status]], drowsiness, lethargy		**[[Altered mental status (peds)\|Altered mental status]], drowsiness, lethargy
			**Breath fruity odor (acetone)
	***Perform a thorough neurologic exam as cerebral edema increases mortality significantly, especially in children		***Perform a thorough neurologic exam as cerebral edema increases mortality significantly, especially in children
	*+/- signs/symptoms of precipitating trigger for decompensation (e.g. [[pneumonia]], [[cellulitis]])		*+/- signs/symptoms of precipitating trigger for decompensation (e.g. [[pneumonia]], [[cellulitis]])