Key Learning Points
- Diagnosis of DKA is:
- Blood glucose >11 mmol/l
- pH < 7.3 or bicarbonate <15 mmol/L
- Blood ketones >3mmol/L
- All children with DKA should receive a fluid bolus, the rate of which should be based on whether they are clinically shocked or not.
- The severity of DKA is based upon the degree of acidosis and can be categorised as mild, moderate and severe.
- Each category is associated with an assumed dehydration fluid deficit and this must be replaced along with the required maintenance fluids, over 48 hours.
- Replacement fluid is : 0.9% Saline with 20mmol KCL in 500ml.
- Insulin at a rate of 0.05units/kg/hour ( or 1 unit/kg/hour if severe DKA or adolescent) should be started at least 1 hour after starting fluid replacement therapy.
- As glucose levels drop, glucose will need to be added the fluid.
- Risk factors for cerebral oedema include young age, new onset T1DM, longer duration of symptoms, severe acidosis & bicarbonate correction.
- Suspected cerebral oedema should be treated with hypertonic saline.
- Patients will need regular observations and repeat blood tests whilst they are on they are being treated for DKA.