dka_flashcards
What are the diagnostic criteria for DKA (Diabetic Ketoacidosis)?
Plasma glucose >11 mmol/litre, ketosis (plasma ketone >3 mmol/litre or ketonuria >++), acidosis (pH <7.3 or HCO3 <15 mmol/litre).
What initial assessments should be recorded when DKA is diagnosed?
Record level of consciousness, vital signs (HR, BP, Temp, RR, Kussmaul breathing), history of nausea or vomiting, clinical evidence of dehydration, body weight.
What measurements should be taken when DKA is diagnosed?
Measure pH and pCO2 (Venous blood gas), U&E, plasma bicarbonate.
When should children with DKA be cared for with one-to-one nursing?
Children < 2 years old, severe DKA. Consider PICU transfer if one-one nursing is not available in the above settings.
What is the initial fluid therapy for clinically dehydrated children with DKA?
Initial fluid bolus at 10ml/kg of 0.9% NaCl over 30 minutes, consider further fluid bolus if needed to improve tissue perfusion after clinical reassessment.
How is the fluid deficit calculated for DKA patients?
5% fluid deficit in mild DKA (pH 7.2-7.29), 7% fluid deficit in moderate DKA (pH 7.1-7.19), 10% fluid deficit in severe DKA (pH < 7.1), fluid bolus at 10 ml/kg. Shocked patients: fluid bolus volume does NOT need to be subtracted from estimated fluid deficit. Non-shocked: subtract from total fluid deficit. Fluid deficit should be replaced over 48 hours.
What is the maintenance fluid requirement for children with DKA?
100ml/kg/day for first 10kg, 50ml/kg/day for next 10kg, 20ml/kg/day for each additional kilogram above 20kg.
Which fluids should be used for rehydration and maintenance in DKA patients?
0.9% saline without added glucose should be used for rehydration and maintenance until plasma glucose is < 14 mmol/L, then change to 0.9% saline + 5% glucose. Ensure all fluids (except boluses) administered to children with DKA contain 40 mmol/L potassium chloride (unless anuric or potassium >5.5 mmol/L).
When should glucose be added to the rehydration fluids in DKA patients?
Add 5% glucose to the fluid once blood glucose is <14 mmol/L.
When should IV fluids be stopped in DKA patients?
Only consider stopping IV fluids if ketosis is resolving, the child is alert, and can take oral fluids without nausea or vomiting.
When should IV insulin therapy be started in children with DKA?
Start IV insulin infusion 1-2 hours after beginning IV fluid therapy in children with DKA.
What dosage of insulin should be used for IV insulin infusion in DKA patients?
Use a soluble insulin infusion at a dose 0.05-0.1 units/kg/hour. Do NOT give bolus doses of insulin.
When should the insulin dosage be increased during DKA treatment?
If the blood ketone level is NOT falling after 6-8 hours, think about increasing the insulin dosage to 0.1 units/kg/hour or more AND seek senior help.
When should the transition from IV insulin to SC insulin occur in DKA patients?
Do NOT change from IV insulin to SC insulin until ketosis is resolving (<1 mmol/L), the child is alert, and can take oral fluids without nausea or vomiting. Start SC insulin in the child at least 30 mins BEFORE stopping IV insulin.
What considerations should be made for insulin pump users during DKA treatment?
If using an insulin pump, start the pump at least 60 mins BEFORE stopping the IV insulin. Change the insulin cartridge and infusion set, and insert the cannula into a new SC site.
