Back to Diabetes Basics Treatment of DKA

Diabetic ketoacidosis, or DKA, is severe, out-of-control diabetes (high blood sugar) that needs emergency treatment. DKA is caused by a profound lack of circulating insulin. This may happen because of illness, taking too little insulin, or getting too little exercise. The body starts using stored fat for energy, and ketone bodies (acids) build up in the blood. DKA also accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. Furthermore, treating DKA incorrectly can result in cerebral edema and death.

The Barbara Davis Center for Childhood Diabetes in Denver, Colorado, has prepared an excellent poster for hospital emergency rooms with the correct treatment procedures for DKA and suspected cerebral edema. The guidelines are as follows:

Severe DKA:

  1. Venous (or arterial) pH < 7.10
  2. HCO3 <8 mEq/L
  3. Usually large urine ketones on dipstick
  4. Breath may have "fruity" odor
  5. Often Kassmaul respirations
  6. Treat at facility with pediatric ICU

Treatment of DKA:

  1. Rehydration: 20 ml/kg bolus in first 1-2 hours (NS or LR)
  2. NPO if vomiting
  3. Insulin drop: 0.1 U/kg per hour IV
  4. If still dehydrated after 1-2 hours: can repeat bolus of 20 ml/kg NS or LR over 1-2 hours--MAXIMUM BOLUS MUST BE <40 ml/kg;; then fluilds (0.45NS) at 1.5 times maintenance. Give no more than 4L of fluid/m2/24 hours (including initial bolus)
  5. Add potassium (K+) when pH > 7.1 and serum K+ known to be normal or low (may use 20 mEq/L KPO4 and 20 mEq/L KAc [or KCl])
  6. Aim for glucose fall of 100 mg/dl per hour
  7. Add 5% dextrose to IV when blood glucose falls to 200-250 mg/dl
  8. Repeat electrolytes and venous pH hourly until pH > 7.1; then repeat every 2 hours until > 7.2 and then every 4 hours until > 7.3

Cerebral Edema: A Clinical Emergency!

References and Additional Information

  1. Type 1 Diabetes Treatment poster by H. Peter Chase, M.D., University of Colorado Health Sciences Center, 1999.
  2. Diabetic Ketoacidosis in Children from the Barbara Davis Center Keystone Conference 2008
  3. DKA Treatment Protocol-Denver. (PDF)
  4. Diabetic ketoacidosis in children and adolescents with diabetes from ISPAD
  5. Diabetic ketoacidosis (DKA) Guidelines from the Great Ormand Hospital for Children (NHS).
  6. Management of Hyperglycemic Crises in Patients With Diabetes (also in PDF format)
  7. Pediatrics, Diabetic Ketoacidosis from eMedicine
  8. Deep Venous Thrombosis in Children With Diabetic Ketoacidosis and Femoral Central Venous Catheters.

27 May 2011

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Last Updated: Thursday February 27, 2014 19:28:21
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