Management Algorithm of Diabetes Ketoacidosis

Client/patient received/Initial
assessment

Clinical Sign
Clinical history Assess for dehydration
Poly symptoms Kussmaul breathing Laboratory Findings
Weight loss Smell for ketones Elevated blood glucose
Abdominal pain Urine ketone

Confirmed DKA

IV Fluid
Insulin Potassium
Start insulin after the first
bolus fluid*

Mild DKA Give after the child

Moderate/ received the first bolus and
Severe DKA 0.5 U SC regular
after adequate urine out put
insulin every 6hr.
give the first dose
 Give 40meq per liter
potassium serum K+ is 3-4.
Therapy  If serum K+ is > 5
Start with SC insulin. Withhold potassium
Shock Switch to BID
Continue oral fluids
SC insulin when
acidosis resolved**

Yes

0.9% Nacl
10ml/kg over
Airway+ NG tube 1 hr.
Breathing (100% oxygen)
Circulation (0.9% Nacl
20ml/kg
fast, repeat if
needed
 Rehydrate slowly over 48hr.
Begin with 0.9% Nacl.

* In standard setting with IV perfuser, give 0.1 unit/kg/hr in fusion, 0.05

unit/kg (for infants) When RBS is < 250mg/dl switch to
0.45%
** Acidosis is said to be resolved using the bio chemical N* In standard setting with IV perfuser,
markers
give
HCO3 (total Co2) > 15meq/l, PH > 7.30, Serum Sodium between 0.1 unit/kg/hr in fusion, 0.05
135–145meq/l, but in the absence of this markers negative urine infants)
unit/kg (for
ketone can be used. ** Acidosis is said to be resolved using the bio
chemical markers